|
HC CATH CATALYST THROM
|
Facility
OP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,493.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,301.88
|
| 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: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Senior |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,600.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,604.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,604.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.25
|
| Rate for Payer: 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC CATH CLEANER THROM
|
Facility
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,650.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,361.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,135.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,018.11
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,922.30
|
| Rate for Payer: Dignity Health Senior |
$2,922.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,591.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,591.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.50
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,253.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,148.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
|
HC CATH CLEANER THROM
|
Facility
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,650.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,361.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cash Price |
$1,547.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,856.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,327.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2,327.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,719.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.50
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,253.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,148.64
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
IP
|
$25,656.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,643.74 |
| Max. Negotiated Rate |
$19,242.00 |
| Rate for Payer: Adventist Health Commercial |
$5,131.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,625.67
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,369.11
|
| Rate for Payer: Heritage Provider Network Senior |
$17,369.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,643.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.00
|
| Rate for Payer: Multiplan Commercial |
$19,242.00
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
OP
|
$25,656.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,420.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,131.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,625.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cash Price |
$11,545.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,676.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,881.06
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$8,072.95
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,643.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$19,242.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
OP
|
$12,694.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,734.81 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$2,538.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,720.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,251.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,857.59
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$1,734.81
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,297.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,173.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$9,520.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
OP
|
$14,959.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,734.81 |
| Max. Negotiated Rate |
$13,568.56 |
| Rate for Payer: Adventist Health Commercial |
$2,991.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,276.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,723.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,259.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: IEHP Medi-Cal |
$1,734.81
|
| Rate for Payer: IEHP Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,739.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$11,219.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
IP
|
$12,694.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,297.61 |
| Max. Negotiated Rate |
$9,520.50 |
| Rate for Payer: Adventist Health Commercial |
$2,538.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,720.78
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,593.84
|
| Rate for Payer: Heritage Provider Network Senior |
$8,593.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,297.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,173.50
|
| Rate for Payer: Multiplan Commercial |
$9,520.50
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
IP
|
$14,959.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
906820281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,707.58 |
| Max. Negotiated Rate |
$11,219.25 |
| Rate for Payer: Adventist Health Commercial |
$2,991.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,276.83
|
| Rate for Payer: Cash Price |
$6,731.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,127.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,127.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,739.75
|
| Rate for Payer: Multiplan Commercial |
$11,219.25
|
|
|
HC CATH EMBO TRELLIS
|
Facility
IP
|
$5,237.50
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$947.99 |
| Max. Negotiated Rate |
$3,928.12 |
| Rate for Payer: Adventist Health Commercial |
$1,047.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,598.16
|
| Rate for Payer: Cash Price |
$2,356.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,545.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,545.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.38
|
| Rate for Payer: Multiplan Commercial |
$3,928.12
|
|
|
HC CATH EMBO TRELLIS
|
Facility
OP
|
$5,237.50
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.67 |
| Max. Negotiated Rate |
$4,451.88 |
| Rate for Payer: Adventist Health Commercial |
$1,047.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,598.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,451.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,880.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,928.12
|
| Rate for Payer: Blue Shield of California Commercial |
$3,252.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,074.41
|
| Rate for Payer: Cash Price |
$2,356.88
|
| Rate for Payer: Cash Price |
$2,356.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.88
|
| Rate for Payer: Dignity Health Senior |
$4,451.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,404.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,242.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,242.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,524.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.38
|
| Rate for Payer: Multiplan Commercial |
$3,928.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.88
|
|
|
HC CATHERIZATION UMBILICAL ARTERY
|
Facility
IP
|
$352.00
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
988136660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.82
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$238.30
|
| Rate for Payer: Heritage Provider Network Senior |
$238.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
|
|
HC CATHERIZATION UMBILICAL ARTERY
|
Facility
OP
|
$352.00
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
988136660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$70.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$241.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$299.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$193.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$264.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$228.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$299.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$299.20
|
| Rate for Payer: Dignity Health Senior |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.89
|
| Rate for Payer: Heritage Provider Network Senior |
$217.89
|
| Rate for Payer: IEHP Medi-Cal |
$49.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$169.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Vantage Medical Group Senior |
$299.20
|
|
|
HC CATHETER CHAIT
|
Facility
OP
|
$580.00
|
|
| Hospital Charge Code |
909020082
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.18
|
| Rate for Payer: Blue Shield of California EPN |
$340.46
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 |
$279.56
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATHETER CHAIT
|
Facility
IP
|
$580.00
|
|
| Hospital Charge Code |
909020082
|
|
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: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 CATHETER CONDOM 29MM MED
|
Facility
OP
|
$6.55
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC CATHETER CONDOM 29MM MED
|
Facility
IP
|
$6.55
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.50
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
|
|
HC CATHETER CONDOM 36MM LG
|
Facility
OP
|
$6.55
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$5.57 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.84
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC CATHETER CONDOM 36MM LG
|
Facility
IP
|
$6.55
|
|
|
Service Code
|
CPT A4349
|
| Hospital Charge Code |
901698374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.50
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
|
|
HC CATHETER/DIAGNOSTIC FLUSH
|
Facility
OP
|
$99.00
|
|
| Hospital Charge Code |
909081205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$54.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.25
|
| Rate for Payer: Blue Shield of California Commercial |
$61.48
|
| Rate for Payer: Blue Shield of California EPN |
$58.11
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.15
|
| Rate for Payer: Dignity Health Senior |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Vantage Medical Group Senior |
$84.15
|
|
|
HC CATHETER/DIAGNOSTIC FLUSH
|
Facility
IP
|
$99.00
|
|
| Hospital Charge Code |
909081205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC CATHETER DOUBLE LUMEN (COOK)
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909001063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$96.26
|
| Rate for Payer: Blue Shield of California EPN |
$90.98
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$131.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$131.75
|
| Rate for Payer: Dignity Health Senior |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$131.75
|
| Rate for Payer: Vantage Medical Group Senior |
$131.75
|
|
|
HC CATHETER DOUBLE LUMEN (COOK)
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909001063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cash Price |
$69.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.94
|
| Rate for Payer: Heritage Provider Network Senior |
$104.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.79
|
|
|
HC CATHETER/GUIDING
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.86
|
| Rate for Payer: Heritage Provider Network Senior |
$121.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC CATHETER/GUIDING
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$111.78
|
| Rate for Payer: Blue Shield of California EPN |
$105.66
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$117.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Senior |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$86.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
