|
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: Aetna of CA Non-Gatekeeper |
$76.64
|
| 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 Foundation Hospitals 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 |
$42.51 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.72
|
| 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 Medi-Cal |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.51
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$36.00
|
| Rate for Payer: Blue Shield of California EPN |
$28.88
|
| 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: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.81
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$4.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$6.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.93
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
| Rate for Payer: Vantage Medical Group Senior |
$4.48
|
|
|
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: Aetna of CA Non-Gatekeeper |
$225.40
|
| 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 Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
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 |
$144.98 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| 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 Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.98
|
| Rate for Payer: Blue Shield of California Commercial |
$144.69
|
| Rate for Payer: Blue Shield of California Commercial |
$144.69
|
| Rate for Payer: Blue Shield of California EPN |
$116.05
|
| 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: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$166.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$19.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
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 Non-Gatekeeper |
$473.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.15
|
| 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 |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| 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) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$365.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| 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 |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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: Aetna of CA Non-Gatekeeper |
$493.30
|
| 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 Foundation Hospitals Medi-Cal |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.50
|
| Rate for Payer: Multiplan Commercial |
$574.50
|
|
|
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: Aetna of CA Non-Gatekeeper |
$9,482.90
|
| 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 Foundation Hospitals 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 ACC BILIARY TREE PERCU
|
Facility
|
OP
|
$14,725.00
|
|
|
Service Code
|
CPT 47541
|
| Hospital Charge Code |
909047541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,665.22 |
| Max. Negotiated Rate |
$15,820.18 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,100.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,326.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$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 |
$12,489.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,159.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,326.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,326.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,114.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,241.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$15,820.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,665.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,575.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,681.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,157.39
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,159.05
|
| Rate for Payer: TriValley Medical Group Senior |
$9,159.05
|
| 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 |
$12,489.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Vantage Medical Group Senior |
$8,326.41
|
|
|
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: Aetna of CA Non-Gatekeeper |
$665.90
|
| 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 Foundation Hospitals 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 |
$187.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$639.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| 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) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$493.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$775.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$910.78
|
| Rate for Payer: TriValley Medical Group Senior |
$910.78
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
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 |
$158.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.60
|
| 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 |
$3,672.00
|
| 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: 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$418.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$565.43
|
| 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 Foundation Hospitals 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
|
OP
|
$9,022.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
909050432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,632.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,804.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,575.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,688.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,584.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,306.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,108.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,632.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,091.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,255.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$6,766.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,957.44
|
| Rate for Payer: TriValley Medical Group Senior |
$2,957.44
|
| 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 |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
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: Aetna of CA Non-Gatekeeper |
$5,810.17
|
| 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 Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$5,909.99
|
| 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 Foundation Hospitals 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
|
|
|
HC PLCMNT NEPHU CATH PERCU
|
Facility
|
OP
|
$9,177.00
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
909050433
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,661.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,835.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,671.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,129.65
|
| Rate for Payer: Cash Price |
$4,129.65
|
| Rate for Payer: Cash Price |
$4,129.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,965.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,533.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,680.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5,576.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,614.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,661.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,213.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,294.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$6,882.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,987.08
|
| Rate for Payer: TriValley Medical Group Senior |
$4,987.08
|
| 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 |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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 |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$570.95
|
| Rate for Payer: Blue Shield of California EPN |
$454.36
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$781.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$781.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| 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) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$573.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$901.50
|
| Rate for Payer: Multiplan WC |
$1,110.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$721.20
|
| Rate for Payer: TriValley Medical Group Senior |
$721.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
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: Aetna of CA Non-Gatekeeper |
$774.09
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.75
|
| Rate for Payer: Heritage Provider Network Senior |
$813.75
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$7,130.37
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,495.74
|
| Rate for Payer: Heritage Provider Network Senior |
$7,495.74
|
| Rate for Payer: Kaiser Foundation Hospitals 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 GT 5YR
|
Facility
|
OP
|
$11,072.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
909080010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,004.03 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Adventist Health Commercial |
$2,214.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,842.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,196.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,853.57
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,004.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,768.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,304.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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: Aetna of CA Non-Gatekeeper |
$6,554.63
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,890.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,890.51
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$1,842.22 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,290.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,615.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,300.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| 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 |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
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: Aetna of CA Non-Gatekeeper |
$6,554.63
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,890.51
|
| Rate for Payer: Heritage Provider Network Senior |
$6,890.51
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,842.22 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,035.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,290.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$4,580.10
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cash Price |
$4,580.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,615.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,300.18
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,842.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,544.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$7,633.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$1,666.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,841.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,688.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,372.38
|
| Rate for Payer: Blue Shield of California EPN |
$3,479.49
|
| Rate for Payer: Cash Price |
$4,142.25
|
| Rate for Payer: Cash Price |
$4,142.25
|
| Rate for Payer: Cash Price |
$4,142.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,983.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| 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) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,390.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,666.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,301.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,903.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,523.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,523.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
