|
HC CATH GLDPTH DIALYSIS 23CM
|
Facility
|
OP
|
$1,017.50
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909020180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$203.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$488.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$699.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$864.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$559.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$763.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$409.04
|
| Rate for Payer: Blue Shield of California EPN |
$409.04
|
| Rate for Payer: Cash Price |
$559.62
|
| Rate for Payer: Cash Price |
$559.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$468.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$864.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.88
|
| Rate for Payer: Dignity Health Senior |
$864.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.10
|
| Rate for Payer: Heritage Provider Network Senior |
$471.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$254.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$712.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$712.25
|
| Rate for Payer: Multiplan Commercial |
$763.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$367.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$336.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$864.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.88
|
| Rate for Payer: Vantage Medical Group Senior |
$864.88
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
IP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,031.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$863.58
|
| Rate for Payer: Blue Shield of California EPN |
$863.58
|
| Rate for Payer: Cash Price |
$1,181.51
|
| Rate for Payer: Cash Price |
$1,181.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$994.62
|
| Rate for Payer: Heritage Provider Network Senior |
$994.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.05
|
| Rate for Payer: Multiplan Commercial |
$1,611.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$776.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$711.27
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
OP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,475.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,611.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$863.58
|
| Rate for Payer: Blue Shield of California EPN |
$863.58
|
| Rate for Payer: Cash Price |
$1,181.51
|
| Rate for Payer: Cash Price |
$1,181.51
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,825.97
|
| Rate for Payer: Dignity Health Senior |
$1,825.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$994.62
|
| Rate for Payer: Heritage Provider Network Senior |
$994.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,503.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,503.74
|
| Rate for Payer: Multiplan Commercial |
$1,611.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$776.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$711.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,825.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,825.97
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
OP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$319.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Blue Shield of California EPN |
$151.25
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$319.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$319.80
|
| Rate for Payer: Dignity Health Senior |
$319.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Senior |
$174.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.37
|
| Rate for Payer: Multiplan Commercial |
$282.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$319.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$319.80
|
| Rate for Payer: Vantage Medical Group Senior |
$319.80
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
IP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.25
|
| Rate for Payer: Blue Shield of California EPN |
$151.25
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Cash Price |
$206.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Senior |
$174.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.06
|
| Rate for Payer: Multiplan Commercial |
$282.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$124.57
|
|
|
HC CATH INDIGO THROM
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC CATH INDIGO THROM
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,959.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,959.75
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,761.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,614.11
|
|
|
HC CATH INTRVASC U/S
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,520.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,606.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,415.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,462.50
|
| Rate for Payer: Dignity Health Senior |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,430.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,430.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,675.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,675.00
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,896.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,738.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,462.50
|
|
|
HC CATH INTRVASC U/S
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,110.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,110.50
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Cash Price |
$2,887.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,415.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,835.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,430.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,430.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,896.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,738.28
|
|
|
HC CATH KIT RADIAL 20GA 4FR
|
Facility
|
IP
|
$121.82
|
|
| Hospital Charge Code |
901698370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$91.36 |
| Rate for Payer: Adventist Health Commercial |
$24.36
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.47
|
| Rate for Payer: Heritage Provider Network Senior |
$82.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.45
|
| Rate for Payer: Multiplan Commercial |
$91.36
|
|
|
HC CATH KIT RADIAL 20GA 4FR
|
Facility
|
OP
|
$121.82
|
|
| Hospital Charge Code |
901698370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Adventist Health Commercial |
$24.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.36
|
| Rate for Payer: Blue Shield of California Commercial |
$74.31
|
| Rate for Payer: Blue Shield of California EPN |
$59.45
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.55
|
| Rate for Payer: Dignity Health Senior |
$103.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.41
|
| Rate for Payer: Heritage Provider Network Senior |
$75.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.27
|
| Rate for Payer: Multiplan Commercial |
$91.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$60.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.55
|
| Rate for Payer: Vantage Medical Group Senior |
$103.55
|
|
|
HC CATH MUSTANG 3.0X40X135
|
Facility
|
IP
|
$874.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
900102367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Adventist Health Commercial |
$174.90
|
| Rate for Payer: Cash Price |
$480.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.04
|
| Rate for Payer: Heritage Provider Network Senior |
$592.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.62
|
| Rate for Payer: Multiplan Commercial |
$655.88
|
|
|
HC CATH MUSTANG 3.0X40X135
|
Facility
|
OP
|
$874.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
900102367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$743.33 |
| Rate for Payer: Adventist Health Commercial |
$174.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$467.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$480.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$655.88
|
| Rate for Payer: Blue Shield of California Commercial |
$533.45
|
| Rate for Payer: Blue Shield of California EPN |
$426.76
|
| Rate for Payer: Cash Price |
$480.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.33
|
| Rate for Payer: Dignity Health Senior |
$743.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.32
|
| Rate for Payer: Heritage Provider Network Senior |
$541.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$417.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.15
|
| Rate for Payer: Multiplan Commercial |
$655.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$437.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.33
|
| Rate for Payer: Vantage Medical Group Senior |
$743.33
|
|
|
HC CATH MUSTANG 5.0X60X135
|
Facility
|
OP
|
$874.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
900102368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$743.33 |
| Rate for Payer: Adventist Health Commercial |
$174.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$467.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$480.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$655.88
|
| Rate for Payer: Blue Shield of California Commercial |
$533.45
|
| Rate for Payer: Blue Shield of California EPN |
$426.76
|
| Rate for Payer: Cash Price |
$480.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$568.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.33
|
| Rate for Payer: Dignity Health Senior |
$743.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.32
|
| Rate for Payer: Heritage Provider Network Senior |
$541.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$417.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.15
|
| Rate for Payer: Multiplan Commercial |
$655.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$437.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.33
|
| Rate for Payer: Vantage Medical Group Senior |
$743.33
|
|
|
HC CATH MUSTANG 5.0X60X135
|
Facility
|
IP
|
$874.50
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
900102368
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.28 |
| Max. Negotiated Rate |
$655.88 |
| Rate for Payer: Adventist Health Commercial |
$174.90
|
| Rate for Payer: Cash Price |
$480.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$592.04
|
| Rate for Payer: Heritage Provider Network Senior |
$592.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.62
|
| Rate for Payer: Multiplan Commercial |
$655.88
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
IP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,234.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,896.71
|
| Rate for Payer: Blue Shield of California EPN |
$6,896.71
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,891.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,264.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,943.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,943.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,578.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,289.00
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,198.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,680.35
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
OP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$14,582.60 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,234.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,786.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,435.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,867.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,896.71
|
| Rate for Payer: Blue Shield of California EPN |
$6,896.71
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Cash Price |
$9,435.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,891.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,582.60
|
| Rate for Payer: Dignity Health Senior |
$14,582.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,979.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,943.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,943.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,578.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,289.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,009.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,009.20
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,198.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,680.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14,582.60
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$233.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.16
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$192.04
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$233.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.16
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Senior |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$192.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH PICC PWR 4.5FR 55CM SL
|
Facility
|
IP
|
$1,405.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.17 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$281.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$674.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$565.15
|
| Rate for Payer: Blue Shield of California EPN |
$565.15
|
| Rate for Payer: Cash Price |
$773.22
|
| Rate for Payer: Cash Price |
$773.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$646.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$759.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.91
|
| Rate for Payer: Heritage Provider Network Senior |
$650.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$702.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.46
|
| Rate for Payer: Multiplan Commercial |
$1,054.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$507.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$465.48
|
|
|
HC CATH PICC PWR 4.5FR 55CM SL
|
Facility
|
OP
|
$1,405.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.17 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$281.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$674.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$965.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$565.15
|
| Rate for Payer: Blue Shield of California EPN |
$565.15
|
| Rate for Payer: Cash Price |
$773.22
|
| Rate for Payer: Cash Price |
$773.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$646.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,194.97
|
| Rate for Payer: Dignity Health Senior |
$1,194.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.91
|
| Rate for Payer: Heritage Provider Network Senior |
$650.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$702.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.10
|
| Rate for Payer: Multiplan Commercial |
$1,054.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$507.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$465.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,194.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,194.97
|
|
