|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$13,040.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,360.24 |
| Max. Negotiated Rate |
$9,780.00 |
| Rate for Payer: Adventist Health Commercial |
$2,608.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,397.76
|
| Rate for Payer: Cash Price |
$5,868.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,828.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8,828.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,360.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,260.00
|
| Rate for Payer: Multiplan Commercial |
$9,780.00
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$13,040.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,360.24 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$2,608.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,058.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| 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 |
$5,868.00
|
| Rate for Payer: Cash Price |
$5,868.00
|
| Rate for Payer: Cash Price |
$5,868.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,476.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,824.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,071.76
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,360.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,260.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$9,780.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$26,083.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,119.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| 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 |
$11,737.35
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,953.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,649.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,145.38
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,721.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$26,083.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$19,562.25 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,797.45
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,658.19
|
| Rate for Payer: Heritage Provider Network Senior |
$17,658.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,721.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$26,083.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,119.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| 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 |
$11,737.35
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,953.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,649.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,145.38
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,721.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$26,083.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$19,562.25 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,797.45
|
| Rate for Payer: Cash Price |
$11,737.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,658.19
|
| Rate for Payer: Heritage Provider Network Senior |
$17,658.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,721.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
OP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,524.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,026.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,661.96
|
| 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 |
$3,294.45
|
| Rate for Payer: Cash Price |
$3,294.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,222.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,222.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,319.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,531.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,531.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,492.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,325.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,124.70
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,660.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,660.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,222.85
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
IP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$5,490.75 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,714.72
|
| Rate for Payer: Cash Price |
$3,294.45
|
| Rate for Payer: Cash Price |
$3,294.45
|
| 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 |
$1,325.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.25
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.86
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$388.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$448.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$611.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$692.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$692.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.49
|
| Rate for Payer: Heritage Provider Network Senior |
$504.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$388.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$570.50
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$692.75
|
| Rate for Payer: Vantage Medical Group Senior |
$692.75
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.51 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.86
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$551.75
|
| Rate for Payer: Heritage Provider Network Senior |
$551.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.75
|
| Rate for Payer: Multiplan Commercial |
$611.25
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.73 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,194.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,953.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$1,597.95
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,308.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,018.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,018.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,198.07
|
| Rate for Payer: Heritage Provider Network Senior |
$2,198.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,693.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,485.70
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,018.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,018.35
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.73 |
| Max. Negotiated Rate |
$2,663.25 |
| Rate for Payer: Adventist Health Commercial |
$710.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,286.84
|
| Rate for Payer: Cash Price |
$1,597.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,404.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,404.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$642.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.75
|
| Rate for Payer: Multiplan Commercial |
$2,663.25
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$301.39
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC INTR NDL/INRCTH CRTD/VERT ART
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 36100
|
| Hospital Charge Code |
909036100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$304.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$397.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$397.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$397.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.69
|
| Rate for Payer: Heritage Provider Network Senior |
$289.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$223.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$327.60
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$397.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$397.80
|
| Rate for Payer: Vantage Medical Group Senior |
$397.80
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.08
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC INTRO AGENT/PACK VAGINAL HEMOR
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
900501470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$543.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.26
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cash Price |
$395.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$260.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$419.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$527.40
|
| Rate for Payer: TriValley Medical Group Senior |
$527.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$1,151.25 |
| Rate for Payer: Adventist Health Commercial |
$307.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$988.54
|
| Rate for Payer: Cash Price |
$690.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.75
|
| Rate for Payer: Multiplan Commercial |
$1,151.25
|
|
|
HC INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
909036901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$10,829.24 |
| Rate for Payer: Adventist Health Commercial |
$307.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$948.63
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$690.75
|
| Rate for Payer: Cash Price |
$690.75
|
| Rate for Payer: Cash Price |
$690.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$997.75
|
| 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 |
$950.16
|
| 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 |
$277.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$1,151.25
|
| 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 INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.17
|
| Rate for Payer: Heritage Provider Network Senior |
$292.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC INTRO CATH RHRT/ MAIN PULM ART
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
909081311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.97
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.54
|
| Rate for Payer: Heritage Provider Network Senior |
$319.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$319.42
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$319.42
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.79
|
| Rate for Payer: Heritage Provider Network Senior |
$335.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
|
|
HC INTRO CATH SUP/INF VENA CAVA
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081308
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$306.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$372.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$322.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$421.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$421.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.02
|
| Rate for Payer: Heritage Provider Network Senior |
$307.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$236.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$421.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$421.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.60
|
|
