|
HC CASE CONSULT
|
Facility
OP
|
$146.00
|
|
| Hospital Charge Code |
905104308
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$78.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$109.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$94.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: Dignity Health Senior |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.37
|
| Rate for Payer: Heritage Provider Network Senior |
$90.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC CASE CONSULT
|
Facility
IP
|
$146.00
|
|
| Hospital Charge Code |
905104308
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$100.30
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$98.84
|
| Rate for Payer: Heritage Provider Network Senior |
$98.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
|
|
HC CASH MAIN PROGRAM PER MONTH
|
Facility
IP
|
$109.00
|
|
| Hospital Charge Code |
900419070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CASH MAIN PROGRAM PER MONTH
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
900419070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$58.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Senior |
$92.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.47
|
| Rate for Payer: Heritage Provider Network Senior |
$67.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$237.75 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.78
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.61
|
| Rate for Payer: Heritage Provider Network Senior |
$214.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$211.37 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.37
|
| Rate for Payer: Blue Shield of California Commercial |
$197.22
|
| Rate for Payer: Blue Shield of California EPN |
$154.17
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.78
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Humana Medicare |
$25.25
|
| Rate for Payer: IEHP Medi-Cal |
$35.02
|
| Rate for Payer: IEHP Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$211.37 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.37
|
| Rate for Payer: Blue Shield of California Commercial |
$197.22
|
| Rate for Payer: Blue Shield of California EPN |
$154.17
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.78
|
| Rate for Payer: Dignity Health Senior |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Humana Medicare |
$25.25
|
| Rate for Payer: IEHP Medi-Cal |
$35.02
|
| Rate for Payer: IEHP Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.82
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
IP
|
$317.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$237.75 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.78
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$214.61
|
| Rate for Payer: Heritage Provider Network Senior |
$214.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.25
|
| Rate for Payer: Multiplan Commercial |
$237.75
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
IP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$989.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$974.88
|
| Rate for Payer: Heritage Provider Network Senior |
$974.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$525.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$481.10
|
|
|
HC CATH, ARROW-TRETOTOLA THROMBOL
|
Facility
OP
|
$1,440.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$691.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$989.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$894.24
|
| Rate for Payer: Blue Shield of California EPN |
$845.28
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$662.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,224.00
|
| Rate for Payer: Dignity Health Senior |
$1,224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$921.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$525.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
HC CATH ATHERECTOMY CROSSER
|
Facility
OP
|
$4,737.50
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909020040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.49 |
| Max. Negotiated Rate |
$9,389.21 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,389.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,254.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,605.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,553.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,941.99
|
| Rate for Payer: Blue Shield of California EPN |
$2,780.91
|
| Rate for Payer: Cash Price |
$2,131.88
|
| Rate for Payer: Cash Price |
$2,131.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,079.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,026.88
|
| Rate for Payer: Dignity Health Senior |
$4,026.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,079.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,283.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,026.88
|
|
|
HC CATH ATHERECTOMY CROSSER
|
Facility
IP
|
$4,737.50
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909020040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.49 |
| Max. Negotiated Rate |
$3,553.12 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,131.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,207.29
|
| Rate for Payer: Heritage Provider Network Senior |
$3,207.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
|
|
HC CATH BALLOON DRUG COATED
|
Facility
IP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,280.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,185.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,565.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,215.75
|
| Rate for Payer: Heritage Provider Network Senior |
$3,215.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,731.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,586.98
|
|
|
HC CATH BALLOON DRUG COATED
|
Facility
OP
|
$4,750.00
|
|
|
Service Code
|
CPT C2623
|
| Hospital Charge Code |
909081859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,280.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,949.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,788.25
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,040.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,199.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,731.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,586.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC CATH BALLOON PURSUIT
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$302.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$426.51
|
| Rate for Payer: Heritage Provider Network Senior |
$426.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.48
|
|
|
HC CATH BALLOON PURSUIT
|
Facility
OP
|
$630.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$302.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$432.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$472.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$391.23
|
| Rate for Payer: Blue Shield of California EPN |
$369.81
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: Dignity Health Senior |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.69
|
| Rate for Payer: Heritage Provider Network Senior |
$291.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$229.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$210.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC CATH BAYLIS PROTRAK
|
Facility
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.10 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,009.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,816.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,716.98
|
| Rate for Payer: Cash Price |
$1,316.25
|
| Rate for Payer: Cash Price |
$1,316.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,901.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,486.25
|
| Rate for Payer: Dignity Health Senior |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,901.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,409.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.25
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
HC CATH BAYLIS PROTRAK
|
Facility
IP
|
$2,925.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.42 |
| Max. Negotiated Rate |
$2,193.75 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,009.48
|
| Rate for Payer: Cash Price |
$1,316.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,980.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,980.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$529.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.25
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
IP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$561.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$585.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$426.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$390.90
|
|
|
HC CATH BLLN CORDIS MAXI LD
|
Facility
OP
|
$1,170.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$561.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$726.57
|
| Rate for Payer: Blue Shield of California EPN |
$686.79
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$994.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$994.50
|
| Rate for Payer: Dignity Health Senior |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$541.71
|
| Rate for Payer: Heritage Provider Network Senior |
$541.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$585.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$426.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$390.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$994.50
|
| Rate for Payer: Vantage Medical Group Senior |
$994.50
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
OP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$558.90
|
| Rate for Payer: Blue Shield of California EPN |
$528.30
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Senior |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$328.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$300.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC CATH BLLN CORDIS PWRFLEX EXTRM
|
Facility
IP
|
$900.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$432.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$328.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$300.69
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
OP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,607.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,453.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,373.58
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,076.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,989.00
|
| Rate for Payer: Dignity Health Senior |
$1,989.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,083.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$853.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$781.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
HC CATH BLLN JUPITER PTA
|
Facility
IP
|
$2,340.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081412
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,607.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,076.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,584.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,584.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$853.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$781.79
|
|
|
HC CATH CATALYST THROM
|
Facility
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,700.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,864.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cash Price |
$2,531.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,587.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,037.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,808.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,808.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.25
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,050.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,879.31
|
|
