|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$759.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,035.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$897.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,173.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,173.85
|
| Rate for Payer: Dignity Health Senior |
$1,173.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$854.84
|
| Rate for Payer: Heritage Provider Network Senior |
$854.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$665.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.25
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,173.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,173.85
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.96 |
| Max. Negotiated Rate |
$1,035.75 |
| Rate for Payer: Adventist Health Commercial |
$276.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.75
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$934.94
|
| Rate for Payer: Heritage Provider Network Senior |
$934.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.25
|
| Rate for Payer: Multiplan Commercial |
$1,035.75
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$434.25 |
| Rate for Payer: Adventist Health Commercial |
$115.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$397.77
|
| Rate for Payer: Cash Price |
$260.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.98
|
| Rate for Payer: Heritage Provider Network Senior |
$391.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.75
|
| Rate for Payer: Multiplan Commercial |
$434.25
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$229.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.66 |
| Max. Negotiated Rate |
$10,500.11 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,661.17
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,571.70
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,496.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$808.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.50
|
| 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 |
$1,813.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| 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 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 INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.62 |
| Max. Negotiated Rate |
$1,349.25 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.91
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,217.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,217.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.75
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.66 |
| Max. Negotiated Rate |
$1,813.50 |
| Rate for Payer: Adventist Health Commercial |
$483.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,661.17
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,636.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,636.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.50
|
| Rate for Payer: Multiplan Commercial |
$1,813.50
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.62 |
| Max. Negotiated Rate |
$10,500.11 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.91
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,169.35
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,113.58
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$808.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$449.75
|
| 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 |
$1,349.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| 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 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 INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.44 |
| Max. Negotiated Rate |
$1,182.75 |
| Rate for Payer: Adventist Health Commercial |
$315.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,083.40
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,067.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,067.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.25
|
| Rate for Payer: Multiplan Commercial |
$1,182.75
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$315.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,083.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$867.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,182.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Cash Price |
$709.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,340.45
|
| Rate for Payer: Dignity Health Senior |
$1,340.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.16
|
| Rate for Payer: Heritage Provider Network Senior |
$976.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$760.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.25
|
| Rate for Payer: Multiplan Commercial |
$1,182.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,340.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,340.45
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$522.75
|
| Rate for Payer: Dignity Health Senior |
$522.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$380.68
|
| Rate for Payer: Heritage Provider Network Senior |
$380.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$461.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$522.75
|
| Rate for Payer: Vantage Medical Group Senior |
$522.75
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$461.25 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.50
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.36
|
| Rate for Payer: Heritage Provider Network Senior |
$416.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$461.25
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$522.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$399.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$522.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$522.75
|
| Rate for Payer: Dignity Health Senior |
$522.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.36
|
| Rate for Payer: Heritage Provider Network Senior |
$416.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$461.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$205.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$522.75
|
| Rate for Payer: Vantage Medical Group Senior |
$522.75
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.32 |
| Max. Negotiated Rate |
$461.25 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.50
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$416.36
|
| Rate for Payer: Heritage Provider Network Senior |
$416.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$461.25
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$561.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$363.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$561.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.00
|
| Rate for Payer: Dignity Health Senior |
$561.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.54
|
| Rate for Payer: Heritage Provider Network Senior |
$408.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.00
|
| Rate for Payer: Vantage Medical Group Senior |
$561.00
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
909081371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$561.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$363.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$561.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.00
|
| Rate for Payer: Dignity Health Senior |
$561.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.00
|
| Rate for Payer: Vantage Medical Group Senior |
$561.00
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
906820183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.85 |
| Max. Negotiated Rate |
$1,134.75 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,039.43
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,024.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,024.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.25
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
|
|
HC INTRO NEEDLE OR INTRACATH EXTREMITY ARTERY
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
906820183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,039.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,286.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$832.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,134.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$983.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,286.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,286.05
|
| Rate for Payer: Dignity Health Senior |
$1,286.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$936.55
|
| Rate for Payer: Heritage Provider Network Senior |
$936.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$729.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$273.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.25
|
| Rate for Payer: Multiplan Commercial |
$1,134.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,286.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,286.05
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Blue Shield of California Commercial |
$83.84
|
| Rate for Payer: Blue Shield of California EPN |
$79.24
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Senior |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC INTUSSUSCEPTION REDUCTION SYST
|
Facility
|
IP
|
$135.00
|
|
| Hospital Charge Code |
909001061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.40
|
| Rate for Payer: Heritage Provider Network Senior |
$91.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$163.83
|
| Rate for Payer: Heritage Provider Network Senior |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
|
|
HC IONTOPHORESIS 15 MIN MCAL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 97033
|
| Hospital Charge Code |
900400027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$157.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Senior |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.80
|
| Rate for Payer: Heritage Provider Network Senior |
$149.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$116.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
