|
HC INSERT NON-TNEL CV CATH LT 5YR
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
906812249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Adventist Health Commercial |
$530.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,640.17
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,260.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,003.21
|
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,725.10
|
| 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 |
$1,796.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,796.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,265.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$480.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,990.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,592.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,592.40
|
| 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 NON-TNNL CV CATH LT 5YR
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
HC INSERT NON-TNNL CV CATH LT 5YR
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
CPT 36555
|
| Hospital Charge Code |
909081358
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$480.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$530.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,640.17
|
| 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 |
$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 |
$1,194.30
|
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Cash Price |
$1,194.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,725.10
|
| 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 |
$1,642.83
|
| 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 |
$480.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,990.50
|
| 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 |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$3,979.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$2,984.25 |
| Rate for Payer: Adventist Health Commercial |
$795.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,562.48
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,693.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,693.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.75
|
| Rate for Payer: Multiplan Commercial |
$2,984.25
|
|
|
HC INSERT NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$3,979.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$795.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,459.02
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,890.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,504.06
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,586.35
|
| 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 |
$2,693.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,693.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,897.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,984.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,387.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,387.40
|
| 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 NON-TUNNEL CV CATH GT 5YR
|
Facility
|
OP
|
$3,979.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$795.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,459.02
|
| 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 |
$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 |
$1,790.55
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,586.35
|
| 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 |
$2,463.00
|
| 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 |
$720.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,984.25
|
| 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 |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 NON-TUNNEL CV CATH GT 5YR
|
Facility
|
IP
|
$3,979.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
906812248
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$2,984.25 |
| Rate for Payer: Adventist Health Commercial |
$795.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,562.48
|
| Rate for Payer: Cash Price |
$1,790.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,693.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,693.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.75
|
| Rate for Payer: Multiplan Commercial |
$2,984.25
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$23,333.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$19,833.05 |
| Rate for Payer: Adventist Health Commercial |
$4,666.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,419.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,833.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,833.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,499.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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 |
$10,499.85
|
| Rate for Payer: Cash Price |
$10,499.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,166.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,833.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,833.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,833.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,443.13
|
| Rate for Payer: Heritage Provider Network Senior |
$14,443.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11,129.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,223.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,833.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16,333.10
|
| Rate for Payer: Multiplan Commercial |
$17,499.75
|
| 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 |
$19,833.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,833.05
|
| Rate for Payer: Vantage Medical Group Senior |
$19,833.05
|
|
|
HC INSERT PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$23,333.00
|
|
|
Service Code
|
CPT 33995
|
| Hospital Charge Code |
906811995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,223.27 |
| Max. Negotiated Rate |
$17,499.75 |
| Rate for Payer: Adventist Health Commercial |
$4,666.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,026.45
|
| Rate for Payer: Cash Price |
$10,499.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,796.44
|
| Rate for Payer: Heritage Provider Network Senior |
$15,796.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,223.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,833.25
|
| Rate for Payer: Multiplan Commercial |
$17,499.75
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
IP
|
$10,810.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,956.61 |
| Max. Negotiated Rate |
$8,107.50 |
| Rate for Payer: Adventist Health Commercial |
$2,162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,961.64
|
| Rate for Payer: Cash Price |
$4,864.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,318.37
|
| Rate for Payer: Heritage Provider Network Senior |
$7,318.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,956.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.50
|
| Rate for Payer: Multiplan Commercial |
$8,107.50
|
|
|
HC INSERT PERM INTRAPERITONEAL CATH/DIALYSIS
|
Facility
|
OP
|
$10,810.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
909000217
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,956.61 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,680.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| 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 |
$4,864.50
|
| Rate for Payer: Cash Price |
$4,864.50
|
| Rate for Payer: Cash Price |
$4,864.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,026.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,691.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,956.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,702.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$8,107.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| 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 |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
OP
|
$9,262.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,676.42 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,852.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,723.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| 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 |
$4,167.90
|
| Rate for Payer: Cash Price |
$4,167.90
|
| Rate for Payer: Cash Price |
$4,167.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,020.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,733.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,664.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,749.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,676.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,315.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$6,946.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,065.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,065.49
|
| 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 |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC INSERT PLEURAL CATH W CUFF
|
Facility
|
IP
|
$9,262.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
909020011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,676.42 |
| Max. Negotiated Rate |
$6,946.50 |
| Rate for Payer: Adventist Health Commercial |
$1,852.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,964.73
|
| Rate for Payer: Cash Price |
$4,167.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,270.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,270.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,676.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,315.50
|
| Rate for Payer: Multiplan Commercial |
$6,946.50
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,739.20
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC INSERT & REMOVE BONE PIN/WIRE
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 20650
|
| Hospital Charge Code |
900501245
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,547.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,781.70
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,415.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,415.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
OP
|
$58,366.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,103.00 |
| Max. Negotiated Rate |
$76,705.51 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,070.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40,371.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37,937.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$44,408.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,371.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$40,371.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,128.55
|
| Rate for Payer: Heritage Provider Network Senior |
$49,656.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40,371.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$76,705.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,427.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$54,097.57
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
| Rate for Payer: Multiplan WC |
$64,907.85
|
| Rate for Payer: TriValley Medical Group Commercial |
$44,408.45
|
| Rate for Payer: TriValley Medical Group Senior |
$44,408.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66,017.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55,527.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60,556.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44,408.45
|
| Rate for Payer: Vantage Medical Group Senior |
$40,371.32
|
|
|
HC INSERT SUBQ DEFIB WELTRD
|
Facility
|
IP
|
$58,366.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
906811456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,564.25 |
| Max. Negotiated Rate |
$43,774.50 |
| Rate for Payer: Adventist Health Commercial |
$11,673.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,587.70
|
| Rate for Payer: Cash Price |
$26,264.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,513.78
|
| Rate for Payer: Heritage Provider Network Senior |
$39,513.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,564.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,591.50
|
| Rate for Payer: Multiplan Commercial |
$43,774.50
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
OP
|
$6,744.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,220.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,348.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,167.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| 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 |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,383.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,174.54
|
| Rate for Payer: Heritage Provider Network Senior |
$3,306.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,108.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,220.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,686.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$5,058.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,957.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,957.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC INSERT SUPRAPUBIC CATH
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
909020122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,220.66 |
| Max. Negotiated Rate |
$5,058.00 |
| Rate for Payer: Adventist Health Commercial |
$1,348.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,343.14
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,565.69
|
| Rate for Payer: Heritage Provider Network Senior |
$4,565.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,220.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,686.00
|
| Rate for Payer: Multiplan Commercial |
$5,058.00
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$6,245.00 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.38
|
| 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 |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$949.52
|
| Rate for Payer: Blue Shield of California EPN |
$755.62
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,299.35
|
| 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 |
$1,299.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,353.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,353.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$953.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,199.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,199.40
|
| 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 INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$1,499.25 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,287.36
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,353.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,353.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.75
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,287.36
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$361.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.75
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
|
|
HC INSERT SWAN TYPE CATHETER
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 93503
|
| Hospital Charge Code |
906811388
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,235.38
|
| 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 |
$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 |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$1,179.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,237.38
|
| 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 |
$361.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,024.63
|
| 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 |
$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 INSERT TEMP INDWELLING CATH
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906811256
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$496.25
|
| 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 |
$489.83
|
| Rate for Payer: Blue Shield of California EPN |
$391.86
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$521.95
|
| 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 |
$497.06
|
| Rate for Payer: Heritage Provider Network Senior |
$497.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$383.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
| 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 |
$401.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$401.50
|
| 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 TEMP INDWELLING CATH
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
906811256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.34 |
| Max. Negotiated Rate |
$602.25 |
| Rate for Payer: Adventist Health Commercial |
$160.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.13
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$543.63
|
| Rate for Payer: Heritage Provider Network Senior |
$543.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.75
|
| Rate for Payer: Multiplan Commercial |
$602.25
|
|
