|
HC CATH ATHERECTOMY CROSSER
|
Facility
|
OP
|
$4,737.50
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909020040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.49 |
| Max. Negotiated Rate |
$4,026.88 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,532.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,254.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,605.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,553.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,889.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.90
|
| Rate for Payer: Cash Price |
$2,605.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,079.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,026.88
|
| Rate for Payer: Dignity Health Senior |
$4,026.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,079.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,259.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,316.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,316.25
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,368.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,368.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,026.88
|
|
|
HC CATH BALLOON DRUG COATED
|
Facility
|
IP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,909.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,185.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,565.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,199.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,716.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,572.72
|
|
|
HC CATH BALLOON DRUG COATED
|
Facility
|
OP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,280.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,909.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,199.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,325.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,325.00
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,716.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,572.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC CATH BALLOON PURSUIT
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$302.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| 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 |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| 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 Permanente of CA Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA 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 CATH BALLOON PURSUIT
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$302.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.81
|
| 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 |
$13,240.00
|
| 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 |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| 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 Senior |
$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 Permanente of CA Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$441.00
|
| Rate for Payer: Molina Healthcare of CA 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 CATH BAYLIS PROTRAK
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.42 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,563.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,009.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,901.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Senior |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,901.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,395.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,047.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,462.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC CATH BAYLIS PROTRAK
|
Facility
|
IP
|
$2,925.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.42 |
| Max. Negotiated Rate |
$2,193.75 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Cash Price |
$1,608.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,980.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,980.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.25
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$561.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$470.34
|
| Rate for Payer: Blue Shield of California EPN |
$470.34
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.71
|
| Rate for Payer: Heritage Provider Network Senior |
$541.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$585.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$819.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$561.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$470.34
|
| Rate for Payer: Blue Shield of California EPN |
$470.34
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.71
|
| Rate for Payer: Heritage Provider Network Senior |
$541.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$585.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.39
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.80
|
| Rate for Payer: Blue Shield of California EPN |
$361.80
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Senior |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.80
|
| Rate for Payer: Blue Shield of California EPN |
$361.80
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,607.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$940.68
|
| Rate for Payer: Blue Shield of California EPN |
$940.68
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,076.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Senior |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,638.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$845.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$774.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$940.68
|
| Rate for Payer: Blue Shield of California EPN |
$940.68
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,076.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$845.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$774.77
|
|
|
HC CATH CATALYST THROM
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,700.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.25
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,587.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,037.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,604.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,604.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,032.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.44
|
|
|
HC CATH CATALYST THROM
|
Facility
|
OP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,700.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,864.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.25
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,587.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Senior |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,600.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,604.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,604.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,937.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,032.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC CATH CLEANER THROM
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,650.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,382.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.08
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,856.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,591.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,591.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.50
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,242.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,138.32
|
|
|
HC CATH CLEANER THROM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,650.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,361.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,382.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.08
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,922.30
|
| Rate for Payer: Dignity Health Senior |
$2,922.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,591.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,591.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,406.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,406.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,242.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,138.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$21,897.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,963.36 |
| Max. Negotiated Rate |
$16,422.75 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Cash Price |
$12,043.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,824.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,824.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,963.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$21,897.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,043.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$12,043.35
|
| Rate for Payer: Cash Price |
$12,043.35
|
| Rate for Payer: Cash Price |
$12,043.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,233.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,554.24
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8,383.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,963.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$10,834.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,960.95 |
| Max. Negotiated Rate |
$8,125.50 |
| Rate for Payer: Adventist Health Commercial |
$2,166.80
|
| Rate for Payer: Cash Price |
$5,958.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,334.62
|
| Rate for Payer: Heritage Provider Network Senior |
$7,334.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,708.50
|
| Rate for Payer: Multiplan Commercial |
$8,125.50
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,801.54 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,762.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,237.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,796.61
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,801.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,552.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$10,658.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$10,834.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,801.54 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,442.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$5,958.70
|
| Rate for Payer: Cash Price |
$5,958.70
|
| Rate for Payer: Cash Price |
$5,958.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,042.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,706.25
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,801.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,960.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,708.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$8,125.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$14,211.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,572.19 |
| Max. Negotiated Rate |
$10,658.25 |
| Rate for Payer: Adventist Health Commercial |
$2,842.20
|
| Rate for Payer: Cash Price |
$7,816.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,620.85
|
| Rate for Payer: Heritage Provider Network Senior |
$9,620.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,552.75
|
| Rate for Payer: Multiplan Commercial |
$10,658.25
|
|
|
HC CATH EMBO TRELLIS
|
Facility
|
OP
|
$5,237.50
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.99 |
| Max. Negotiated Rate |
$4,451.88 |
| Rate for Payer: Adventist Health Commercial |
$1,047.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,799.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,598.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,928.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,194.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,555.90
|
| Rate for Payer: Cash Price |
$2,880.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.88
|
| Rate for Payer: Dignity Health Senior |
$4,451.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,404.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,242.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,242.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,498.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,666.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,666.25
|
| Rate for Payer: Multiplan Commercial |
$3,928.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,618.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,618.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.88
|
|
|
HC CATH EMBO TRELLIS
|
Facility
|
IP
|
$5,237.50
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.99 |
| Max. Negotiated Rate |
$3,928.12 |
| Rate for Payer: Adventist Health Commercial |
$1,047.50
|
| Rate for Payer: Cash Price |
$2,880.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,545.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,545.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.38
|
| Rate for Payer: Multiplan Commercial |
$3,928.12
|
|
