|
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: Aetna of CA Non-Gatekeeper |
$5,928.02
|
| Rate for Payer: Cash Price |
$4,142.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,231.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,231.78
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$5,928.02
|
| Rate for Payer: Cash Price |
$4,142.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,231.78
|
| Rate for Payer: Heritage Provider Network Senior |
$6,231.78
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
361
|
| Min. Negotiated Rate |
$1,666.11 |
| Max. Negotiated Rate |
$10,001.00 |
| 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 |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| 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 |
$5,697.90
|
| 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 |
$1,666.11
|
| 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 |
$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 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: Aetna of CA Non-Gatekeeper |
$8,410.00
|
| Rate for Payer: Cash Price |
$5,876.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,840.94
|
| Rate for Payer: Heritage Provider Network Senior |
$8,840.94
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$2,363.68 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,070.46
|
| 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 |
$5,876.55
|
| Rate for Payer: Cash Price |
$5,876.55
|
| Rate for Payer: Cash Price |
$5,876.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,488.35
|
| 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 |
$8,083.52
|
| 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 |
$2,363.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,264.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$9,794.25
|
| 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 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: Aetna of CA Non-Gatekeeper |
$2,557.32
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,688.37
|
| Rate for Payer: Heritage Provider Network Senior |
$2,688.37
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$718.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$794.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,454.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| 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 |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cash Price |
$1,786.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,581.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,458.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$718.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,978.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,183.03
|
| Rate for Payer: Cash Price |
$826.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,243.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,243.65
|
| Rate for Payer: Kaiser Foundation Hospitals 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 PERC CATH WO IMAGE
|
Facility
|
OP
|
$1,837.00
|
|
|
Service Code
|
CPT 32556
|
| Hospital Charge Code |
909032556
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$367.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,135.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| 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 |
$826.65
|
| Rate for Payer: Cash Price |
$826.65
|
| Rate for Payer: Cash Price |
$826.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,194.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,468.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,137.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3,035.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,689.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$332.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,838.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$1,377.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,714.84
|
| Rate for Payer: TriValley Medical Group Senior |
$2,714.84
|
| 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 |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,830.25
|
| Rate for Payer: Cash Price |
$1,278.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,924.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,924.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.50
|
| Rate for Payer: Multiplan Commercial |
$2,131.50
|
|
|
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 |
$514.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$568.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,278.90
|
| Rate for Payer: Cash Price |
$1,278.90
|
| Rate for Payer: Cash Price |
$1,278.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,847.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,759.20
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$514.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,131.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$170.66
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
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 Non-Gatekeeper |
$163.77
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$132.55
|
| 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 |
$119.25
|
| 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 Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$164.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$126.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$1,512.11
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,589.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,589.60
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$424.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| 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 |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,526.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,453.41
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| 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 |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC PLEURX CHEST DRAIN
|
Facility
|
IP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$542.34
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$554.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$558.01
|
| Rate for Payer: Heritage Provider Network Senior |
$558.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$602.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$602.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.30
|
| 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
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.81
|
| 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 |
$13,770.00
|
| 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 |
$542.34
|
| Rate for Payer: Cash Price |
$542.34
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$602.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$602.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,219.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,085.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,479.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$793.15
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$907.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,677.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,677.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.50
|
| Rate for Payer: Heritage Provider Network Senior |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$986.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$986.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,381.10
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$712.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$653.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,677.05
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,270.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$793.15
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$907.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,065.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.50
|
| Rate for Payer: Heritage Provider Network Senior |
$913.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$986.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$986.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.25
|
| Rate for Payer: Multiplan Commercial |
$1,479.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$712.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$653.26
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.87
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.87
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$28.96 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.87
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.15
|
| Rate for Payer: Heritage Provider Network Senior |
$26.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Senior |
$23.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$28.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
