|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$642.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$825.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$781.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.75
|
| Rate for Payer: Heritage Provider Network Senior |
$813.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$573.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
| Rate for Payer: Multiplan WC |
$1,110.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$432.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$397.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC PLCMNT TRANSESOPHEAGEAL PROBE
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
900501593
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$901.50 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Cash Price |
$661.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.75
|
| Rate for Payer: Heritage Provider Network Senior |
$813.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.50
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
OP
|
$11,072.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,214.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,606.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$6,089.60
|
| Rate for Payer: Cash Price |
$6,089.60
|
| Rate for Payer: Cash Price |
$6,089.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,196.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,853.57
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,004.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,768.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$8,304.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP GT 5YR
|
Facility
|
IP
|
$11,072.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,004.03 |
| Max. Negotiated Rate |
$8,304.00 |
| Rate for Payer: Adventist Health Commercial |
$2,214.40
|
| Rate for Payer: Cash Price |
$6,089.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,495.74
|
| Rate for Payer: Heritage Provider Network Senior |
$7,495.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,004.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,768.00
|
| Rate for Payer: Multiplan Commercial |
$8,304.00
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
OP
|
$10,178.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,992.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$5,597.90
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,615.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,300.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$224.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLCMT CENTRLY INSERT TUN CVP LT 5YR
|
Facility
|
IP
|
$10,178.00
|
|
|
Service Code
|
CPT 36557
|
| Hospital Charge Code |
909081359
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,842.22 |
| Max. Negotiated Rate |
$7,633.50 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,890.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,890.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
IP
|
$10,178.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,842.22 |
| Max. Negotiated Rate |
$7,633.50 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,890.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,890.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
|
|
HC PLCMT PERIPH INSRT CV DEVC W/P
|
Facility
|
OP
|
$10,178.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
909080016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,992.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$5,597.90
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Cash Price |
$5,597.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,615.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,300.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$492.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,841.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,323.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$5,062.75
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,983.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,697.90
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$548.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,903.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,666.11 |
| Max. Negotiated Rate |
$6,903.75 |
| Rate for Payer: Adventist Health Commercial |
$1,841.00
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,231.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,231.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.25
|
| Rate for Payer: Multiplan Commercial |
$6,903.75
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
OP
|
$9,205.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,841.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,323.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,983.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,231.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,231.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,390.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,903.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,311.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,047.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLCMT PERIPH INSRT CV DVC W/PO
|
Facility
|
IP
|
$9,205.00
|
|
|
Service Code
|
CPT 36570
|
| Hospital Charge Code |
909080015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,666.11 |
| Max. Negotiated Rate |
$6,903.75 |
| Rate for Payer: Adventist Health Commercial |
$1,841.00
|
| Rate for Payer: Cash Price |
$5,062.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,231.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,231.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.25
|
| Rate for Payer: Multiplan Commercial |
$6,903.75
|
|
|
HC PLC TUN CNTRL VAD W/SUB PRT LT 5YR
|
Facility
|
IP
|
$13,059.00
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
909080011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,363.68 |
| Max. Negotiated Rate |
$9,794.25 |
| Rate for Payer: Adventist Health Commercial |
$2,611.80
|
| Rate for Payer: Cash Price |
$7,182.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,840.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,840.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,363.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,264.75
|
| Rate for Payer: Multiplan Commercial |
$9,794.25
|
|
|
HC PLC TUN CNTRL VAD W/SUB PRT LT 5YR
|
Facility
|
OP
|
$13,059.00
|
|
|
Service Code
|
CPT 36560
|
| Hospital Charge Code |
909080011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,611.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,971.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$7,182.45
|
| Rate for Payer: Cash Price |
$7,182.45
|
| Rate for Payer: Cash Price |
$7,182.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,488.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,083.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$425.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,363.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,264.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$9,794.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PLEURA BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
909000123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.75 |
| Max. Negotiated Rate |
$2,978.25 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Cash Price |
$2,184.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,688.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,688.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$718.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.75
|
| Rate for Payer: Multiplan Commercial |
$2,978.25
|
|
|
HC PLEURA BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
909000123
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,728.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| 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 |
$2,184.05
|
| Rate for Payer: Cash Price |
$2,184.05
|
| Rate for Payer: Cash Price |
$2,184.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,581.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,458.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$718.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$2,978.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC PLEURAL DRAIN PERC CATH WO IMAGE
|
Facility
|
OP
|
$1,837.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
909032556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$367.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,262.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$1,010.35
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,194.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,137.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,579.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,377.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,651.35
|
| Rate for Payer: TriValley Medical Group Senior |
$2,651.35
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC PLEURAL DRAIN PERC CATH WO IMAGE
|
Facility
|
IP
|
$1,837.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
909032556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,377.75 |
| Rate for Payer: Adventist Health Commercial |
$367.40
|
| Rate for Payer: Cash Price |
$1,010.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,243.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,243.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$332.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.25
|
| Rate for Payer: Multiplan Commercial |
$1,377.75
|
|
|
HC PLEURAL DRAIN PLCMNT NO TUNN
|
Facility
|
OP
|
$2,842.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
909020159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$568.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,952.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| 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 |
$1,563.10
|
| Rate for Payer: Cash Price |
$1,563.10
|
| Rate for Payer: Cash Price |
$1,563.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,847.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,759.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,131.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PLEURAL DRAIN PLCMNT NO TUNN
|
Facility
|
IP
|
$2,842.00
|
|
|
Service Code
|
CPT 32557
|
| Hospital Charge Code |
909020159
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$514.40 |
| Max. Negotiated Rate |
$2,131.50 |
| Rate for Payer: Adventist Health Commercial |
$568.40
|
| Rate for Payer: Cash Price |
$1,563.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,924.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,924.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$514.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$2,131.50
|
|
|
HC PLEURA VAC
|
Facility
|
OP
|
$265.00
|
|
| Hospital Charge Code |
909081710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$141.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Blue Shield of California Commercial |
$161.65
|
| Rate for Payer: Blue Shield of California EPN |
$129.32
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Senior |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$164.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$132.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC PLEURA VAC
|
Facility
|
IP
|
$265.00
|
|
| Hospital Charge Code |
909081710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
HC PLEURODESIS
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.99 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Cash Price |
$1,291.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,589.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,589.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
|
|
HC PLEURODESIS
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,613.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| 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 |
$1,291.40
|
| Rate for Payer: Cash Price |
$1,291.40
|
| Rate for Payer: Cash Price |
$1,291.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,526.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,453.41
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$366.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC PLEURX CHEST DRAIN
|
Facility
|
OP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$578.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$827.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$662.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$903.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$484.49
|
| Rate for Payer: Blue Shield of California EPN |
$484.49
|
| Rate for Payer: Cash Price |
$662.86
|
| Rate for Payer: Cash Price |
$662.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$554.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,024.42
|
| Rate for Payer: Dignity Health Senior |
$1,024.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.01
|
| Rate for Payer: Heritage Provider Network Senior |
$558.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$602.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$903.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$435.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$399.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,024.42
|
| Rate for Payer: Vantage Medical Group Senior |
$1,024.42
|
|
