|
HC REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,178.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
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 |
$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 |
$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 |
$238.24
|
| 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 |
$1,842.22
|
| 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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
OP
|
$10,122.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,024.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,953.81
|
| 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 |
$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 |
$5,567.10
|
| Rate for Payer: Cash Price |
$5,567.10
|
| Rate for Payer: Cash Price |
$5,567.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,579.30
|
| 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 |
$6,265.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.24
|
| 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 |
$1,832.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,530.50
|
| 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 |
$7,591.50
|
| 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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,178.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
909080017
|
|
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 REPLC CATH ONLY CV DEVICE W/SU
|
Facility
|
IP
|
$10,122.00
|
|
|
Service Code
|
CPT 36578
|
| Hospital Charge Code |
906820165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,832.08 |
| Max. Negotiated Rate |
$7,591.50 |
| Rate for Payer: Adventist Health Commercial |
$2,024.40
|
| Rate for Payer: Cash Price |
$5,567.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,852.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,852.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,832.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,530.50
|
| Rate for Payer: Multiplan Commercial |
$7,591.50
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,803.65
|
| 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 |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,652.65
|
| 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 |
$2,526.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.40
|
| 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 |
$738.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| 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 |
$3,060.75
|
| 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 REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$738.66 |
| Max. Negotiated Rate |
$3,060.75 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$738.66 |
| Max. Negotiated Rate |
$3,060.75 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,803.65
|
| 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: Cash Price |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,652.65
|
| 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 |
$2,762.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,946.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| 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 |
$3,060.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,468.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,351.22
|
| 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 REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
IP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,000.39 |
| Max. Negotiated Rate |
$4,145.25 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Cash Price |
$3,039.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,741.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,741.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,381.75
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
OP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,797.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$3,039.85
|
| Rate for Payer: Cash Price |
$3,039.85
|
| Rate for Payer: Cash Price |
$3,039.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,592.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,421.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,636.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,381.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,240.58
|
| 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 |
$2,594.35
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.05
|
| 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 |
$2,919.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$102.53
|
| 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 |
$853.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| 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 |
$3,537.75
|
| 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 REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$4,717.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$853.78 |
| Max. Negotiated Rate |
$3,537.75 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,193.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,193.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| Rate for Payer: Multiplan Commercial |
$3,537.75
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$4,717.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$853.78 |
| Max. Negotiated Rate |
$3,537.75 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,193.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,193.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| Rate for Payer: Multiplan Commercial |
$3,537.75
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,240.58
|
| 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: Cash Price |
$2,594.35
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Cash Price |
$2,594.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,066.05
|
| 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 |
$3,193.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,193.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,250.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,179.25
|
| 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 |
$3,537.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,697.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,561.80
|
| 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 REPLC TUN CNTRL INSRT CATH W/O
|
Facility
|
IP
|
$9,078.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,643.12 |
| Max. Negotiated Rate |
$6,808.50 |
| Rate for Payer: Adventist Health Commercial |
$1,815.60
|
| Rate for Payer: Cash Price |
$4,992.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,145.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6,145.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,643.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.50
|
| Rate for Payer: Multiplan Commercial |
$6,808.50
|
|
|
HC REPLC TUN CNTRL INSRT CATH W/O
|
Facility
|
OP
|
$9,078.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,236.59
|
| 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 |
$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 |
$4,992.90
|
| Rate for Payer: Cash Price |
$4,992.90
|
| Rate for Payer: Cash Price |
$4,992.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,900.70
|
| 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 |
$5,619.28
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.47
|
| 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 |
$1,643.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.50
|
| 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 |
$6,808.50
|
| 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 REP LEG TENDON PRIMARY EA
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,055.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,647.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,436.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC REPL TUNNELED CV CATH W PUMP
|
Facility
|
OP
|
$13,989.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
909086583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,797.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,610.44
|
| 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 |
$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 |
$7,693.95
|
| Rate for Payer: Cash Price |
$7,693.95
|
| Rate for Payer: Cash Price |
$7,693.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,092.85
|
| 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 |
$8,659.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.73
|
| 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 |
$2,532.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.25
|
| 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 |
$10,491.75
|
| 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 REPL TUNNELED CV CATH W PUMP
|
Facility
|
IP
|
$13,989.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
909086583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,532.01 |
| Max. Negotiated Rate |
$10,491.75 |
| Rate for Payer: Adventist Health Commercial |
$2,797.80
|
| Rate for Payer: Cash Price |
$7,693.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,470.55
|
| Rate for Payer: Heritage Provider Network Senior |
$9,470.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.25
|
| Rate for Payer: Multiplan Commercial |
$10,491.75
|
|
|
HC REP OF NAIL BED
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$201.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$553.85
|
| Rate for Payer: Cash Price |
$553.85
|
| Rate for Payer: Cash Price |
$553.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$654.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.74
|
| Rate for Payer: Heritage Provider Network Senior |
$681.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$480.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$362.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$333.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP OF NAIL BED
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Adventist Health Commercial |
$201.40
|
| Rate for Payer: Cash Price |
$553.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.74
|
| Rate for Payer: Heritage Provider Network Senior |
$681.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.75
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
|
OP
|
$2,593.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$518.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,781.39
|
| 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 |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,426.15
|
| Rate for Payer: Cash Price |
$1,426.15
|
| Rate for Payer: Cash Price |
$1,426.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,685.45
|
| 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 |
$1,755.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,755.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,236.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.25
|
| 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 |
$1,944.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$932.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$858.54
|
| 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 REPOSITION CENTRAL CATH PICC
|
Facility
|
IP
|
$2,593.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.33 |
| Max. Negotiated Rate |
$1,944.75 |
| Rate for Payer: Adventist Health Commercial |
$518.60
|
| Rate for Payer: Cash Price |
$1,426.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,755.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,755.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$648.25
|
| Rate for Payer: Multiplan Commercial |
$1,944.75
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906820089
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,803.65
|
| 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 |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,652.65
|
| 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 |
$2,526.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.38
|
| 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 |
$738.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| 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 |
$3,060.75
|
| 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
|
|
