|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$44.43 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.43
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$33.40
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
OP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.42
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$9.01
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
IP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$7.95 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.83
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.18
|
| Rate for Payer: Heritage Provider Network Senior |
$7.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.65
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.44
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.71
|
| Rate for Payer: Heritage Provider Network Senior |
$46.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.51
|
| Rate for Payer: Blue Shield of California Commercial |
$42.09
|
| Rate for Payer: Blue Shield of California EPN |
$33.67
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.71
|
| Rate for Payer: Heritage Provider Network Senior |
$42.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$34.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$34.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$58.65
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.67
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.58
|
| Rate for Payer: Heritage Provider Network Senior |
$59.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.02
|
| Rate for Payer: Blue Shield of California Commercial |
$53.68
|
| Rate for Payer: Blue Shield of California EPN |
$42.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$799.85
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.83
|
| Rate for Payer: Heritage Provider Network Senior |
$840.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.80 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$767.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$931.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.25
|
| Rate for Payer: Blue Shield of California Commercial |
$757.62
|
| Rate for Payer: Blue Shield of California EPN |
$606.10
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$807.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,055.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$768.80
|
| Rate for Payer: Heritage Provider Network Senior |
$768.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$592.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$621.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$621.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.04 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Adventist Health Commercial |
$368.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,184.96
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,245.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,245.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
|
|
HC BALLOON, AMPHIRION
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$333.04 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Adventist Health Commercial |
$368.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,137.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,012.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,380.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$920.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.40
|
| Rate for Payer: Blue Shield of California EPN |
$897.92
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,196.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,564.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,564.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,085.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$877.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$333.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$920.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$920.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,564.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,564.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,564.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC BALLOON, ASCENT
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| 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 |
$1,950.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| 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 BALLOON DILATATION CATHETER
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,043.28
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
|
|
HC BALLOON DILATATION CATHETER
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,001.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$810.32
|
| Rate for Payer: Blue Shield of California Commercial |
$988.20
|
| Rate for Payer: Blue Shield of California EPN |
$790.56
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,053.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,002.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,002.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$772.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$810.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$810.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC BALLOON, EV3 EVERCROSS
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$586.50 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.61
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$529.41
|
| Rate for Payer: Heritage Provider Network Senior |
$529.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
|
|
HC BALLOON, EV3 EVERCROSS
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$664.70 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$483.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.16
|
| Rate for Payer: Blue Shield of California Commercial |
$477.02
|
| Rate for Payer: Blue Shield of California EPN |
$381.62
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.06
|
| Rate for Payer: Heritage Provider Network Senior |
$484.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$373.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$391.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC BALLOON GATEWAY
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 BALLOON GATEWAY
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020056
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| 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 |
$13,770.00
|
| 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 |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 BALLOON HYPERFORM
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
909020050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| 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 |
$1,950.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| 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 Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| 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
|
|
