|
HC CATH POWERLINE TUNNELED
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$706.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$591.74
|
| Rate for Payer: Blue Shield of California EPN |
$591.74
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Senior |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$942.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.54
|
| Rate for Payer: Heritage Provider Network Senior |
$681.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$736.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$531.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$487.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC CATH POWERLINE TUNNELED
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$706.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$591.74
|
| Rate for Payer: Blue Shield of California EPN |
$591.74
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.54
|
| Rate for Payer: Heritage Provider Network Senior |
$681.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$736.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$531.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$487.38
|
|
|
HC CATH RESCUE
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
900800869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC CATH RESCUE
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
900800869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$310.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$353.80
|
| Rate for Payer: Blue Shield of California EPN |
$283.04
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Senior |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$276.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: 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 |
$290.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$290.00
|
| 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 RESCUE SUCTION OMNEOTECH
|
Facility
|
OP
|
$374.10
|
|
| Hospital Charge Code |
900800713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$317.99 |
| Rate for Payer: Adventist Health Commercial |
$74.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.57
|
| Rate for Payer: Blue Shield of California Commercial |
$228.20
|
| Rate for Payer: Blue Shield of California EPN |
$182.56
|
| Rate for Payer: Cash Price |
$205.76
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.99
|
| Rate for Payer: Dignity Health Senior |
$317.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.57
|
| Rate for Payer: Heritage Provider Network Senior |
$231.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.87
|
| Rate for Payer: Multiplan Commercial |
$280.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.99
|
|
|
HC CATH RESCUE SUCTION OMNEOTECH
|
Facility
|
IP
|
$374.10
|
|
| Hospital Charge Code |
900800713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$280.57 |
| Rate for Payer: Adventist Health Commercial |
$74.82
|
| Rate for Payer: Cash Price |
$205.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.27
|
| Rate for Payer: Heritage Provider Network Senior |
$253.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.53
|
| Rate for Payer: Multiplan Commercial |
$280.57
|
|
|
HC CATH SUREFIRE MICROCATH
|
Facility
|
OP
|
$9,574.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909001887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,595.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,577.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,137.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,265.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,180.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,848.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,848.75
|
| Rate for Payer: Cash Price |
$5,265.70
|
| Rate for Payer: Cash Price |
$5,265.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,137.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,137.90
|
| Rate for Payer: Dignity Health Senior |
$8,137.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,432.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4,432.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,787.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,701.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,701.80
|
| Rate for Payer: Multiplan Commercial |
$7,180.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,459.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,169.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,137.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,137.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.90
|
|
|
HC CATH SUREFIRE MICROCATH
|
Facility
|
IP
|
$9,574.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909001887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,595.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,848.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,848.75
|
| Rate for Payer: Cash Price |
$5,265.70
|
| Rate for Payer: Cash Price |
$5,265.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,404.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,169.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,432.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4,432.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,787.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.50
|
| Rate for Payer: Multiplan Commercial |
$7,180.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,459.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,169.95
|
|
|
HC CATH THROMBEC BALLOON
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.09
|
| Rate for Payer: Blue Shield of California EPN |
$299.09
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.40
|
| Rate for Payer: Dignity Health Senior |
$632.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.47
|
| Rate for Payer: Heritage Provider Network Senior |
$344.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$520.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$520.80
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$268.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.40
|
| Rate for Payer: Vantage Medical Group Senior |
$632.40
|
|
|
HC CATH THROMBEC BALLOON
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$299.09
|
| Rate for Payer: Blue Shield of California EPN |
$299.09
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.47
|
| Rate for Payer: Heritage Provider Network Senior |
$344.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$268.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.34
|
|
|
HC CATH THROMBECTOMY PENUMBRA
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$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 THROMBECTOMY PENUMBRA
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$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 TIEMAN COUDE 5CC 14FR
|
Facility
|
OP
|
$86.04
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$73.13 |
| Rate for Payer: Adventist Health Commercial |
$17.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.53
|
| Rate for Payer: Blue Shield of California Commercial |
$52.48
|
| Rate for Payer: Blue Shield of California EPN |
$41.99
|
| Rate for Payer: Cash Price |
$47.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.13
|
| Rate for Payer: Dignity Health Senior |
$73.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.26
|
| Rate for Payer: Heritage Provider Network Senior |
$53.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.23
|
| Rate for Payer: Multiplan Commercial |
$64.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.13
|
| Rate for Payer: Vantage Medical Group Senior |
$73.13
|
|
|
HC CATH TIEMAN COUDE 5CC 14FR
|
Facility
|
IP
|
$86.04
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.53 |
| Rate for Payer: Adventist Health Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$47.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.25
|
| Rate for Payer: Heritage Provider Network Senior |
$58.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.51
|
| Rate for Payer: Multiplan Commercial |
$64.53
|
|
|
HC CATH TIEMAN COUDE 5CC 16FR
|
Facility
|
OP
|
$168.98
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$143.63 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.73
|
| Rate for Payer: Blue Shield of California Commercial |
$103.08
|
| Rate for Payer: Blue Shield of California EPN |
$82.46
|
| Rate for Payer: Cash Price |
$92.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.63
|
| Rate for Payer: Dignity Health Senior |
$143.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.60
|
| Rate for Payer: Heritage Provider Network Senior |
$104.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$118.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.29
|
| Rate for Payer: Multiplan Commercial |
$126.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$84.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$84.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$143.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.63
|
| Rate for Payer: Vantage Medical Group Senior |
$143.63
|
|
|
HC CATH TIEMAN COUDE 5CC 16FR
|
Facility
|
IP
|
$168.98
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.73 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$92.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.40
|
| Rate for Payer: Heritage Provider Network Senior |
$114.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$126.73
|
|
|
HC CATH TIEMAN COUDE 5CC 18FR
|
Facility
|
IP
|
$86.04
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$64.53 |
| Rate for Payer: Adventist Health Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$47.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.25
|
| Rate for Payer: Heritage Provider Network Senior |
$58.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.51
|
| Rate for Payer: Multiplan Commercial |
$64.53
|
|
|
HC CATH TIEMAN COUDE 5CC 18FR
|
Facility
|
OP
|
$86.04
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$73.13 |
| Rate for Payer: Adventist Health Commercial |
$17.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$59.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.53
|
| Rate for Payer: Blue Shield of California Commercial |
$52.48
|
| Rate for Payer: Blue Shield of California EPN |
$41.99
|
| Rate for Payer: Cash Price |
$47.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.13
|
| Rate for Payer: Dignity Health Senior |
$73.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.26
|
| Rate for Payer: Heritage Provider Network Senior |
$53.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.23
|
| Rate for Payer: Multiplan Commercial |
$64.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.13
|
| Rate for Payer: Vantage Medical Group Senior |
$73.13
|
|
|
HC CATH TIEMAN COUDE 5CC 20FR
|
Facility
|
IP
|
$81.36
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$61.02 |
| Rate for Payer: Adventist Health Commercial |
$16.27
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.08
|
| Rate for Payer: Heritage Provider Network Senior |
$55.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$61.02
|
|
|
HC CATH TIEMAN COUDE 5CC 20FR
|
Facility
|
OP
|
$81.36
|
|
|
Service Code
|
CPT A4352
|
| Hospital Charge Code |
901698386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$69.16 |
| Rate for Payer: Adventist Health Commercial |
$16.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.02
|
| Rate for Payer: Blue Shield of California Commercial |
$49.63
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$44.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.16
|
| Rate for Payer: Dignity Health Senior |
$69.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.36
|
| Rate for Payer: Heritage Provider Network Senior |
$50.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.95
|
| Rate for Payer: Multiplan Commercial |
$61.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$40.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$40.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.16
|
| Rate for Payer: Vantage Medical Group Senior |
$69.16
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$2,910.75 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,074.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,367.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,893.93
|
| Rate for Payer: Cash Price |
$2,134.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,522.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,522.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,402.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,402.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,851.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,940.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.34
|
| Rate for Payer: Heritage Provider Network Senior |
$240.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$243.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$301.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$195.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$230.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$301.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$301.75
|
| Rate for Payer: Dignity Health Senior |
$301.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.75
|
| Rate for Payer: Heritage Provider Network Senior |
$219.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.50
|
| Rate for Payer: Multiplan Commercial |
$266.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$301.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$301.75
|
| Rate for Payer: Vantage Medical Group Senior |
$301.75
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
