|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
IP
|
$4,384.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Adventist Health Commercial |
$876.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,011.81
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,967.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.00
|
| Rate for Payer: Multiplan Commercial |
$3,288.00
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
OP
|
$4,384.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$793.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$876.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,011.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Cash Price |
$1,972.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,849.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,713.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,060.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$793.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,096.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,288.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
IP
|
$2,951.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$534.13 |
| Max. Negotiated Rate |
$2,213.25 |
| Rate for Payer: Adventist Health Commercial |
$590.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,027.34
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,997.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,997.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$2,213.25
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
OP
|
$2,951.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$2,508.35 |
| Rate for Payer: Adventist Health Commercial |
$590.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,027.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,508.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,623.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,213.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.90
|
| Rate for Payer: Blue Shield of California Commercial |
$373.36
|
| Rate for Payer: Blue Shield of California EPN |
$212.32
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Cash Price |
$1,327.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,918.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,508.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,508.35
|
| Rate for Payer: Dignity Health Senior |
$2,508.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,918.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,826.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,826.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,422.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$737.75
|
| Rate for Payer: Multiplan Commercial |
$2,213.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,508.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,508.35
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
IP
|
$8,792.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,591.35 |
| Max. Negotiated Rate |
$6,594.00 |
| Rate for Payer: Adventist Health Commercial |
$1,758.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,040.10
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,952.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,952.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$6,594.00
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
OP
|
$8,792.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,758.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,040.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Cash Price |
$3,956.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,714.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,442.25
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$490.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,591.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,594.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$7,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,413.97 |
| Max. Negotiated Rate |
$5,859.00 |
| Rate for Payer: Adventist Health Commercial |
$1,562.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,366.84
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,288.72
|
| Rate for Payer: Heritage Provider Network Senior |
$5,288.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,953.00
|
| Rate for Payer: Multiplan Commercial |
$5,859.00
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$7,812.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,562.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,366.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Cash Price |
$3,515.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,077.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: Dignity Health Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,835.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.80
|
| Rate for Payer: Humana Medicare |
$853.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$709.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,953.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.41
|
| Rate for Payer: Multiplan Commercial |
$5,859.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$938.85
|
| Rate for Payer: TriValley Medical Group Senior |
$938.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,672.84
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,672.84
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,442.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
IP
|
$2,322.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$420.28 |
| Max. Negotiated Rate |
$1,741.50 |
| Rate for Payer: Adventist Health Commercial |
$464.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,595.21
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,571.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,571.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.50
|
| Rate for Payer: Multiplan Commercial |
$1,741.50
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
OP
|
$2,322.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$464.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,595.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cash Price |
$1,044.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,509.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,437.32
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,741.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
IP
|
$7,887.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$5,915.25 |
| Rate for Payer: Adventist Health Commercial |
$1,577.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,418.37
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,339.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5,339.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,427.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,971.75
|
| Rate for Payer: Multiplan Commercial |
$5,915.25
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
OP
|
$7,887.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,577.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,418.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,126.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,882.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,130.19
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,055.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,427.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,971.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$5,915.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,799.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$18,226.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,298.91 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$18,226.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$259.04 |
| Max. Negotiated Rate |
$15,492.10 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$423.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,492.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,024.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,669.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,492.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,492.10
|
| Rate for Payer: Dignity Health Senior |
$15,492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,281.89
|
| Rate for Payer: Heritage Provider Network Senior |
$11,281.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,784.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,492.10
|
| Rate for Payer: Vantage Medical Group Senior |
$15,492.10
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,597.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.06 |
| Max. Negotiated Rate |
$5,697.75 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,597.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$259.04 |
| Max. Negotiated Rate |
$10,231.15 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$423.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,178.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,697.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,457.45
|
| Rate for Payer: Dignity Health Senior |
$6,457.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,702.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,702.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,661.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,457.45
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$2,667.00 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$6,034.04 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,311.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,311.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,713.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,291.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,188.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
900501752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,442.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
