|
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 |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$44.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$51.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.30
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$239.77 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC CATECHOLAMINES UR FRACTIONATED
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.54
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC CATECHOLAMINES URINE FRACTIONATED
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900912199
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$239.77 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.77
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California Commercial |
$203.21
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Blue Shield of California EPN |
$162.99
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.25
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$27.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$889.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$792.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,080.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$720.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,008.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,224.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,224.00
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$578.88
|
| Rate for Payer: Blue Shield of California EPN |
$578.88
|
| 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 |
$666.72
|
| Rate for Payer: Heritage Provider Network Senior |
$666.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$520.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$476.78
|
|
|
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 |
$3,050.95
|
| 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 Foundation Hospitals 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 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 |
$4,026.88 |
| Rate for Payer: Adventist Health Commercial |
$947.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,927.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,605.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,553.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,369.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,889.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,311.90
|
| 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 Medicare Advantage |
$4,026.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,795.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,259.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$857.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,184.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,316.25
|
| Rate for Payer: Multiplan Commercial |
$3,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,368.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,368.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,026.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,026.88
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,935.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,909.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.50
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,375.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,325.00
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,716.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,572.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,059.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,909.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,909.50
|
| 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 |
$2,199.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,199.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,716.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,572.72
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.26
|
| Rate for Payer: Blue Shield of California EPN |
$253.26
|
| 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 |
$291.69
|
| Rate for Payer: Heritage Provider Network Senior |
$291.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$227.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.59
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.26
|
| Rate for Payer: Blue Shield of California EPN |
$253.26
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
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 |
$1,883.70
|
| 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 Foundation Hospitals 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 BAYLIS PROTRAK
|
Facility
|
OP
|
$2,925.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812552
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$529.42 |
| Max. Negotiated Rate |
$2,486.25 |
| Rate for Payer: Adventist Health Commercial |
$585.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,807.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,608.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,193.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,463.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,784.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.40
|
| 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 Medicare Advantage |
$2,486.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,725.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,395.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$529.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$731.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,047.50
|
| Rate for Payer: Multiplan Commercial |
$2,193.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,462.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,462.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,486.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,486.25
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$753.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$470.34
|
| Rate for Payer: Blue Shield of California EPN |
$470.34
|
| 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 |
$541.71
|
| Rate for Payer: Heritage Provider Network Senior |
$541.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$585.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$422.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.39
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$994.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$643.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$877.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$470.34
|
| Rate for Payer: Blue Shield of California EPN |
$470.34
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$585.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$585.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$819.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$422.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$387.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$994.50
|
| 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.80
|
| Rate for Payer: Blue Shield of California EPN |
$361.80
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$361.80
|
| Rate for Payer: Blue Shield of California EPN |
$361.80
|
| 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 |
$416.70
|
| Rate for Payer: Heritage Provider Network Senior |
$416.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$325.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.99
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,506.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$940.68
|
| Rate for Payer: Blue Shield of California EPN |
$940.68
|
| 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 |
$1,083.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,083.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$845.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$774.77
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$468.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,446.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,287.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,755.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$940.68
|
| Rate for Payer: Blue Shield of California EPN |
$940.68
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,170.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,170.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$585.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$845.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$774.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,989.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,989.00
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,622.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.25
|
| 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 |
$2,604.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,604.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$2,032.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.44
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,476.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,261.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,261.25
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,032.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| 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
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,214.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,382.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.08
|
| 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 |
$1,591.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,591.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,242.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,138.32
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,124.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,382.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.08
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,719.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,719.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,406.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,242.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,138.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
