|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
OP
|
$21,897.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,963.36 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,532.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,233.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,554.24
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,963.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC CATH DIALYSIS CRCT W STNT PLC
|
Facility
|
IP
|
$21,897.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
909036903
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,963.36 |
| Max. Negotiated Rate |
$16,422.75 |
| Rate for Payer: Adventist Health Commercial |
$4,379.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,101.67
|
| Rate for Payer: Cash Price |
$9,853.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,824.27
|
| Rate for Payer: Heritage Provider Network Senior |
$14,824.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,963.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,474.25
|
| Rate for Payer: Multiplan Commercial |
$16,422.75
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
OP
|
$10,834.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,960.95 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,695.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$4,875.30
|
| Rate for Payer: Cash Price |
$4,875.30
|
| Rate for Payer: Cash Price |
$4,875.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,042.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,706.25
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,960.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,708.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$8,125.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC CATH DIALYSIS CRCT W TRNS BLLN
|
Facility
|
IP
|
$10,834.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
909036902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,960.95 |
| Max. Negotiated Rate |
$8,125.50 |
| Rate for Payer: Adventist Health Commercial |
$2,166.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,977.10
|
| Rate for Payer: Cash Price |
$4,875.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,334.62
|
| Rate for Payer: Heritage Provider Network Senior |
$7,334.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,960.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,708.50
|
| Rate for Payer: Multiplan Commercial |
$8,125.50
|
|
|
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 |
$3,372.95
|
| 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 Foundation Hospitals 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 |
$947.99 |
| Max. Negotiated Rate |
$4,451.88 |
| Rate for Payer: Adventist Health Commercial |
$1,047.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,236.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,928.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,619.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,194.88
|
| Rate for Payer: Blue Shield of California EPN |
$2,555.90
|
| 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 Medicare Advantage |
$4,451.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,090.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,242.01
|
| Rate for Payer: Heritage Provider Network Senior |
$3,242.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,498.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$947.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,666.25
|
| Rate for Payer: Multiplan Commercial |
$3,928.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,618.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,618.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.88
|
| 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
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
988136660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.45
|
| Rate for Payer: Heritage Provider Network Senior |
$288.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$222.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$326.20
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.10
|
| Rate for Payer: Vantage Medical Group Senior |
$396.10
|
|
|
HC CATHERIZATION UMBILICAL ARTERY
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
988136660
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.10
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.48
|
| Rate for Payer: Heritage Provider Network Senior |
$315.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
|
|
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 Non-Gatekeeper |
$358.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.12
|
| Rate for Payer: Blue Shield of California Commercial |
$353.80
|
| Rate for Payer: Blue Shield of California EPN |
$283.04
|
| Rate for Payer: Cash Price |
$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 Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$276.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$290.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC 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 |
$373.52
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| 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 Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.57
|
| 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 |
$4.22
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.20
|
| 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 Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.58
|
| Rate for Payer: Multiplan Commercial |
$4.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.57
|
| 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 |
$4.22
|
| 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 Foundation Hospitals 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
|
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 |
$63.76
|
| 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 Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
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 Non-Gatekeeper |
$61.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.52
|
| Rate for Payer: Blue Shield of California Commercial |
$60.39
|
| Rate for Payer: Blue Shield of California EPN |
$48.31
|
| 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 Medicare Advantage |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.30
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$49.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$49.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Vantage Medical Group Senior |
$84.15
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$62.31
|
| Rate for Payer: Blue Shield of California EPN |
$62.31
|
| 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 Medicare Advantage |
$131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.77
|
| Rate for Payer: Heritage Provider Network Senior |
$71.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$116.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.75
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$31.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$62.31
|
| Rate for Payer: Blue Shield of California EPN |
$62.31
|
| 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 |
$71.77
|
| Rate for Payer: Heritage Provider Network Senior |
$71.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$77.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$56.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.32
|
|
|
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 Non-Gatekeeper |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.04
|
| Rate for Payer: Blue Shield of California Commercial |
$109.80
|
| Rate for Payer: Blue Shield of California EPN |
$87.84
|
| 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 Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.42
|
| Rate for Payer: Heritage Provider Network Senior |
$111.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$85.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$90.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
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 |
$115.92
|
| 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 Foundation Hospitals Medi-Cal |
$32.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
|
|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.55
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.06
|
| Rate for Payer: Heritage Provider Network Senior |
$113.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
|
|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$125.25 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$108.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.37
|
| Rate for Payer: Heritage Provider Network Senior |
$103.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.34
|
| Rate for Payer: TriValley Medical Group Senior |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
OP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$2,303.93 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,675.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,490.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,032.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,355.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,653.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.72
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,761.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,303.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,303.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,677.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,677.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,292.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,897.35
|
| Rate for Payer: Multiplan Commercial |
$2,032.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,355.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,355.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,303.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,303.93
|
| Rate for Payer: Vantage Medical Group Senior |
$2,303.93
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
IP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$2,032.88 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,745.56
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,835.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,835.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$490.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.62
|
| Rate for Payer: Multiplan Commercial |
$2,032.88
|
|
|
HC CATHETER, MULTI MARKER
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$933.16
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.97
|
| Rate for Payer: Heritage Provider Network Senior |
$980.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$262.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
|
