|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.02
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.87
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$399.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$306.85
|
| Rate for Payer: Blue Shield of California EPN |
$244.19
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$308.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Senior |
$387.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.02
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$437.34
|
| Rate for Payer: Heritage Provider Network Senior |
$437.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$394.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,367.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,349.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,079.94
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,438.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,369.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,369.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,055.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$394.79
|
| Rate for Payer: TriValley Medical Group Senior |
$394.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,106.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,106.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$400.55 |
| Max. Negotiated Rate |
$1,659.75 |
| Rate for Payer: Adventist Health Commercial |
$442.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,425.17
|
| Rate for Payer: Cash Price |
$995.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,498.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,498.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$553.25
|
| Rate for Payer: Multiplan Commercial |
$1,659.75
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$317.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$334.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.17
|
| Rate for Payer: Heritage Provider Network Senior |
$318.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$245.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| 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 |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.03 |
| Max. Negotiated Rate |
$385.50 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$331.02
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.98
|
| Rate for Payer: Heritage Provider Network Senior |
$347.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.50
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
|
|
HC INNER CANNULA
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.46
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
|
|
HC INNER CANNULA
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
900800704
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.86
|
| Rate for Payer: Heritage Provider Network Senior |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
IP
|
$10,884.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,970.00 |
| Max. Negotiated Rate |
$8,163.00 |
| Rate for Payer: Adventist Health Commercial |
$2,176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,009.30
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,368.47
|
| Rate for Payer: Heritage Provider Network Senior |
$7,368.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,970.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,721.00
|
| Rate for Payer: Multiplan Commercial |
$8,163.00
|
|
|
HC INNOMINATE SUBCLAV UNI
|
Facility
|
OP
|
$10,884.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
909020148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,970.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,176.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,726.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$4,897.80
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Cash Price |
$4,897.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,074.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,737.20
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,721.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,163.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
OP
|
$11,115.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,011.82 |
| Max. Negotiated Rate |
$17,246.43 |
| Rate for Payer: Adventist Health Commercial |
$2,223.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,869.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,077.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$5,001.75
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,224.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,077.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,077.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,880.19
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,246.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,011.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,438.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,778.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,163.27
|
| Rate for Payer: Multiplan Commercial |
$8,336.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.78
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.78
|
| Rate for Payer: Vantage Medical Group Senior |
$9,077.07
|
|
|
HC INSERT BRONCHIAL VALVE
|
Facility
|
IP
|
$11,115.00
|
|
|
Service Code
|
CPT 31647
|
| Hospital Charge Code |
900803113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,011.82 |
| Max. Negotiated Rate |
$8,336.25 |
| Rate for Payer: Adventist Health Commercial |
$2,223.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,158.06
|
| Rate for Payer: Cash Price |
$5,001.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,524.85
|
| Rate for Payer: Heritage Provider Network Senior |
$7,524.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,011.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,778.75
|
| Rate for Payer: Multiplan Commercial |
$8,336.25
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
OP
|
$3,302.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$597.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$660.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,040.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,485.90
|
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,146.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,043.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$597.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,476.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| 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 |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC INSERTION PICC W RS &I 5YRS/GT
|
Facility
|
IP
|
$3,302.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
909036573
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$597.66 |
| Max. Negotiated Rate |
$2,476.50 |
| Rate for Payer: Adventist Health Commercial |
$660.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,126.49
|
| Rate for Payer: Cash Price |
$1,485.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,235.45
|
| Rate for Payer: Heritage Provider Network Senior |
$2,235.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$597.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.50
|
| Rate for Payer: Multiplan Commercial |
$2,476.50
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
OP
|
$1,779.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,099.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$800.55
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,156.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,101.20
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$322.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,334.25
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC INSERTION PICC W RS&I LT 5 YRS
|
Facility
|
IP
|
$1,779.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
909036572
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,334.25 |
| Rate for Payer: Adventist Health Commercial |
$355.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,145.68
|
| Rate for Payer: Cash Price |
$800.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,204.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,204.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$322.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.75
|
| Rate for Payer: Multiplan Commercial |
$1,334.25
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
909001904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.52
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
909001904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.75
|
| Rate for Payer: Heritage Provider Network Senior |
$210.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$325.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$188.23
|
| 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 |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.02
|
| Rate for Payer: Blue Shield of California EPN |
$137.62
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.56
|
| Rate for Payer: Heritage Provider Network Senior |
$174.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$134.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.23
|
| Rate for Payer: TriValley Medical Group Senior |
$171.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$141.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
906811389
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.61
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.91
|
| Rate for Payer: Heritage Provider Network Senior |
$190.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
902100048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$174.52
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC INSERT NON-INDWEL BLADDER CATH
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
902100048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$128.72
|
| Rate for Payer: Blue Shield of California EPN |
$102.44
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$129.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Senior |
$162.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.37 |
| Max. Negotiated Rate |
$1,990.50 |
| Rate for Payer: Adventist Health Commercial |
$530.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,709.18
|
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,796.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.50
|
| Rate for Payer: Multiplan Commercial |
$1,990.50
|
|
