|
HC INSERT NON-TNNL CV CATH LT 5YR
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.65 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Adventist Health Commercial |
$485.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,668.72
|
| Rate for Payer: Cash Price |
$1,093.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,644.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,644.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.25
|
| Rate for Payer: Multiplan Commercial |
$1,821.75
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$659.20 |
| Max. Negotiated Rate |
$2,731.50 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,502.05
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,465.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,465.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.50
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$5,741.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906820086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,944.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$2,583.45
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,731.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,553.68
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,502.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| 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 |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,367.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,254.40
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$659.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,502.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,367.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,465.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,465.63
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,755.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,322.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,216.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.20 |
| Max. Negotiated Rate |
$2,731.50 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,502.05
|
| Rate for Payer: Cash Price |
$1,638.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,465.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,465.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.50
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$5,741.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906820086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,039.12 |
| Max. Negotiated Rate |
$4,305.75 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,944.07
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,886.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,886.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$32,231.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906820320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.03 |
| Max. Negotiated Rate |
$27,396.35 |
| Rate for Payer: Adventist Health Commercial |
$6,446.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,142.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,727.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$14,503.95
|
| Rate for Payer: Cash Price |
$14,503.95
|
| Rate for Payer: Cash Price |
$14,503.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,950.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,396.35
|
| Rate for Payer: Dignity Health Senior |
$27,396.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,950.99
|
| Rate for Payer: Heritage Provider Network Senior |
$19,950.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,535.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,833.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,057.75
|
| Rate for Payer: Multiplan Commercial |
$24,173.25
|
| 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 |
$27,396.35
|
| Rate for Payer: Vantage Medical Group Senior |
$27,396.35
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$27,338.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.03 |
| Max. Negotiated Rate |
$23,237.30 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,237.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,035.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,503.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,769.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,237.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,237.30
|
| Rate for Payer: Dignity Health Senior |
$23,237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,922.22
|
| Rate for Payer: Heritage Provider Network Senior |
$16,922.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,176.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
| 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 |
$23,237.30
|
| Rate for Payer: Vantage Medical Group Senior |
$23,237.30
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$27,338.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,948.18 |
| Max. Negotiated Rate |
$20,503.50 |
| Rate for Payer: Adventist Health Commercial |
$5,467.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,781.21
|
| Rate for Payer: Cash Price |
$12,302.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,507.83
|
| Rate for Payer: Heritage Provider Network Senior |
$18,507.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,948.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,834.50
|
| Rate for Payer: Multiplan Commercial |
$20,503.50
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$32,231.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906820320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,833.81 |
| Max. Negotiated Rate |
$24,173.25 |
| Rate for Payer: Adventist Health Commercial |
$6,446.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,142.70
|
| Rate for Payer: Cash Price |
$14,503.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,820.39
|
| Rate for Payer: Heritage Provider Network Senior |
$21,820.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,833.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,057.75
|
| Rate for Payer: Multiplan Commercial |
$24,173.25
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
OP
|
$9,895.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,979.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,797.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$4,452.75
|
| Rate for Payer: Cash Price |
$4,452.75
|
| Rate for Payer: Cash Price |
$4,452.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,431.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,125.00
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$7,421.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
IP
|
$9,895.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,791.00 |
| Max. Negotiated Rate |
$7,421.25 |
| Rate for Payer: Adventist Health Commercial |
$1,979.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,797.86
|
| Rate for Payer: Cash Price |
$4,452.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,698.92
|
| Rate for Payer: Heritage Provider Network Senior |
$6,698.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,473.75
|
| Rate for Payer: Multiplan Commercial |
$7,421.25
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
IP
|
$8,478.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,534.52 |
| Max. Negotiated Rate |
$6,358.50 |
| Rate for Payer: Adventist Health Commercial |
$1,695.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,824.39
|
| Rate for Payer: Cash Price |
$3,815.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,739.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5,739.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,119.50
|
| Rate for Payer: Multiplan Commercial |
$6,358.50
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
OP
|
$8,478.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$935.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,695.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,824.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| 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 |
$3,815.10
|
| Rate for Payer: Cash Price |
$3,815.10
|
| Rate for Payer: Cash Price |
$3,815.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,510.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,247.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$935.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,534.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,119.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$6,358.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
IP
|
$68,385.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12,377.68 |
| Max. Negotiated Rate |
$51,288.75 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$46,296.64
|
| Rate for Payer: Heritage Provider Network Senior |
$46,296.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
OP
|
$79,658.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906820004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.93 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51,777.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$49,308.30
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$793.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
IP
|
$79,658.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906820004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,418.10 |
| Max. Negotiated Rate |
$59,743.50 |
| Rate for Payer: Adventist Health Commercial |
$15,931.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54,725.05
|
| Rate for Payer: Cash Price |
$35,846.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,928.47
|
| Rate for Payer: Heritage Provider Network Senior |
$53,928.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,418.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,914.50
|
| Rate for Payer: Multiplan Commercial |
$59,743.50
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
OP
|
$68,385.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.93 |
| Max. Negotiated Rate |
$78,099.96 |
| Rate for Payer: Adventist Health Commercial |
$13,677.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46,980.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41,105.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cash Price |
$30,773.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44,450.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$45,215.76
|
| Rate for Payer: Dignity Health Senior |
$41,105.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41,105.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,330.32
|
| Rate for Payer: Heritage Provider Network Senior |
$50,559.45
|
| Rate for Payer: Humana Medicare |
$41,105.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$793.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41,105.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,377.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,504.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51,792.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51,792.60
|
| Rate for Payer: Multiplan Commercial |
$51,288.75
|
| Rate for Payer: Multiplan WC |
$56,196.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$45,215.76
|
| Rate for Payer: TriValley Medical Group Senior |
$45,215.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$62,843.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52,858.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61,657.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45,215.76
|
| Rate for Payer: Vantage Medical Group Senior |
$41,105.24
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
OP
|
$6,173.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,240.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$2,777.85
|
| Rate for Payer: Cash Price |
$2,777.85
|
| Rate for Payer: Cash Price |
$2,777.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,012.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,821.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,130.19
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$429.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$4,629.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,799.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
IP
|
$6,173.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.31 |
| Max. Negotiated Rate |
$4,629.75 |
| Rate for Payer: Adventist Health Commercial |
$1,234.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,240.85
|
| Rate for Payer: Cash Price |
$2,777.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,179.12
|
| Rate for Payer: Heritage Provider Network Senior |
$4,179.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,543.25
|
| Rate for Payer: Multiplan Commercial |
$4,629.75
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$3,514.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$636.03 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Adventist Health Commercial |
$702.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,414.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,284.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,284.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,378.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,378.98
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,693.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$636.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,635.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,275.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,174.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$3,514.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$636.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$702.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,414.12
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: Cash Price |
$1,581.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$636.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.50
|
| Rate for Payer: Multiplan Commercial |
$2,635.50
|
|
