|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$448.25
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Senior |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$570.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Senior |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.43
|
| Rate for Payer: Heritage Provider Network Senior |
$574.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$442.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$628.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$928.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$637.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$510.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$603.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$788.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$788.80
|
| Rate for Payer: Dignity Health Senior |
$788.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.43
|
| Rate for Payer: Heritage Provider Network Senior |
$574.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,107.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$442.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.60
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$788.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$788.80
|
| Rate for Payer: Vantage Medical Group Senior |
$788.80
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$928.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.97 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Adventist Health Commercial |
$185.60
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$628.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.00
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$448.25
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Senior |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,107.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$570.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$448.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.73 |
| Max. Negotiated Rate |
$2,663.25 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,404.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,404.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.75
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,439.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,953.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cash Price |
$1,953.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,308.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,018.35
|
| Rate for Payer: Dignity Health Senior |
$3,018.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,198.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,198.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$305.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,693.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,485.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,485.70
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| 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 |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,018.35
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$1,312.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Adventist Health Commercial |
$262.40
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$888.22
|
| Rate for Payer: Heritage Provider Network Senior |
$888.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$1,312.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
906820025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$262.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$901.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,115.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$721.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$984.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,115.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,115.20
|
| Rate for Payer: Dignity Health Senior |
$1,115.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$812.13
|
| Rate for Payer: Heritage Provider Network Senior |
$812.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$625.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$918.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$918.40
|
| Rate for Payer: Multiplan Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,115.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,115.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,115.20
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$304.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$397.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$397.80
|
| Rate for Payer: Dignity Health Senior |
$397.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.69
|
| Rate for Payer: Heritage Provider Network Senior |
$289.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$301.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$223.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$327.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$397.80
|
| Rate for Payer: Vantage Medical Group Senior |
$397.80
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$469.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Senior |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$255.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$419.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.07
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$316.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Adventist Health Commercial |
$307.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,054.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$844.25
|
| Rate for Payer: Cash Price |
$844.25
|
| Rate for Payer: Cash Price |
$844.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$997.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$839.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,151.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$1,151.25 |
| Rate for Payer: Adventist Health Commercial |
$307.00
|
| Rate for Payer: Cash Price |
$844.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.75
|
| Rate for Payer: Multiplan Commercial |
$1,151.25
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.76 |
| Max. Negotiated Rate |
$1,722.75 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,555.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,555.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.25
|
| Rate for Payer: Multiplan Commercial |
$1,722.75
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$2,297.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
906820280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Adventist Health Commercial |
$459.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,578.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,263.35
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Cash Price |
$1,263.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,493.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$839.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$1,722.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| 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 |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.54
|
| Rate for Payer: Heritage Provider Network Senior |
$319.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Senior |
$401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.17
|
| Rate for Payer: Heritage Provider Network Senior |
$292.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$340.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$372.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.60
|
| Rate for Payer: Dignity Health Senior |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.02
|
| Rate for Payer: Heritage Provider Network Senior |
$307.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$236.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$347.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$421.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.60
|
|
