|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.60
|
| Rate for Payer: Blue Shield of California EPN |
$120.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.60
|
| Rate for Payer: Blue Shield of California EPN |
$120.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$108.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.33
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$345.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$494.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.44
|
| Rate for Payer: Blue Shield of California EPN |
$289.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Senior |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.36
|
| Rate for Payer: Heritage Provider Network Senior |
$333.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC PLASTY BALLOON/LP/PF+ CORDIS
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$345.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$289.44
|
| Rate for Payer: Blue Shield of California EPN |
$289.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.36
|
| Rate for Payer: Heritage Provider Network Senior |
$333.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$260.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.39
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$552.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.30
|
| Rate for Payer: Blue Shield of California EPN |
$462.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.45
|
| Rate for Payer: Heritage Provider Network Senior |
$532.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.76
|
|
|
HC PLASTY BALLOON/XXL/MAXI
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$552.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$790.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$862.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.30
|
| Rate for Payer: Blue Shield of California EPN |
$462.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$529.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$977.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.50
|
| Rate for Payer: Dignity Health Senior |
$977.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.45
|
| Rate for Payer: Heritage Provider Network Senior |
$532.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$575.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$805.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$977.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.50
|
| Rate for Payer: Vantage Medical Group Senior |
$977.50
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900910101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.87
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.54 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.56
|
| Rate for Payer: Heritage Provider Network Senior |
$80.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
|
|
HC PLATELET COUNT CITRATED
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
900912026
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$40.87 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.87
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Senior |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$144.69 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$144.69
|
| Rate for Payer: Blue Shield of California EPN |
$116.05
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Senior |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.65
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC PLATELET NEUTRALIZATION
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 85597
|
| Hospital Charge Code |
900912007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC PLATELET PED PAK ALIQUOT
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904532
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$488.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.60
|
| Rate for Payer: Blue Shield of California Commercial |
$557.54
|
| Rate for Payer: Blue Shield of California EPN |
$446.03
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Senior |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$180.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.01
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.19
|
| Rate for Payer: TriValley Medical Group Senior |
$180.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.58
|
| Rate for Payer: Heritage Provider Network Senior |
$518.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
|
|
HC PLATELET SURVIVAL
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 78191
|
| Hospital Charge Code |
909301642
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$1,540.13 |
| Rate for Payer: Adventist Health Commercial |
$153.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$409.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$526.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,540.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,238.52
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cash Price |
$344.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$497.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$474.15
|
| Rate for Payer: Heritage Provider Network Senior |
$474.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$383.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$383.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$14,725.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,063.64 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,116.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,928.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,571.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,892.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,721.05
|
| Rate for Payer: Dignity Health Senior |
$7,928.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,928.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,114.77
|
| Rate for Payer: Heritage Provider Network Senior |
$9,751.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,752.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,928.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,063.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,665.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,681.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,989.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,989.57
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,721.05
|
| Rate for Payer: TriValley Medical Group Senior |
$8,721.05
|
| 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 |
$11,892.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,721.05
|
| Rate for Payer: Vantage Medical Group Senior |
$7,928.23
|
|
|
HC PLCMNT ACC BILIARY TREE PERCU
|
Facility
|
IP
|
$14,725.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,665.22 |
| Max. Negotiated Rate |
$11,043.75 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,968.83
|
| Rate for Payer: Heritage Provider Network Senior |
$9,968.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,665.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,681.25
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$700.02
|
| Rate for Payer: Heritage Provider Network Senior |
$700.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
|
|
HC PLCMNT LCL DVC PERC 1ST LESION
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
909010035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$710.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$630.74
|
| Rate for Payer: Blue Shield of California EPN |
$504.59
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$672.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$640.05
|
| Rate for Payer: Heritage Provider Network Senior |
$640.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$797.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$493.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$893.98
|
| Rate for Payer: TriValley Medical Group Senior |
$893.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$517.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$517.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$482.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$658.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$535.58
|
| Rate for Payer: Blue Shield of California EPN |
$428.46
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$570.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$746.30
|
| Rate for Payer: Dignity Health Senior |
$746.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$543.48
|
| Rate for Payer: Heritage Provider Network Senior |
$543.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$697.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$418.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$614.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$614.60
|
| Rate for Payer: Multiplan Commercial |
$658.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$439.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$439.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$746.30
|
| Rate for Payer: Vantage Medical Group Senior |
$746.30
|
|
|
HC PLCMNT LCL DVC PERC ADD LESION
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
909010036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$658.50 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.41
|
| Rate for Payer: Heritage Provider Network Senior |
$594.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.50
|
| Rate for Payer: Multiplan Commercial |
$658.50
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
IP
|
$9,022.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,632.98 |
| Max. Negotiated Rate |
$6,766.50 |
| Rate for Payer: Adventist Health Commercial |
$1,804.40
|
| Rate for Payer: Cash Price |
$4,059.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,107.89
|
| Rate for Payer: Heritage Provider Network Senior |
$6,107.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,632.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,255.50
|
| Rate for Payer: Multiplan Commercial |
$6,766.50
|
|
|
HC PLCMNT NEPH CATH PERCU
|
Facility
|
OP
|
$9,022.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,804.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,198.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,059.90
|
| Rate for Payer: Cash Price |
$4,059.90
|
| Rate for Payer: Cash Price |
$4,059.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,864.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,584.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,201.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,253.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,945.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,632.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,255.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$6,766.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,863.12
|
| Rate for Payer: TriValley Medical Group Senior |
$2,863.12
|
| 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 |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
IP
|
$9,177.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,661.04 |
| Max. Negotiated Rate |
$6,882.75 |
| Rate for Payer: Adventist Health Commercial |
$1,835.40
|
| Rate for Payer: Cash Price |
$4,129.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,212.83
|
| Rate for Payer: Heritage Provider Network Senior |
$6,212.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,661.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.25
|
| Rate for Payer: Multiplan Commercial |
$6,882.75
|
|
