|
HC RH IMMUNE GLOBULIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.47
|
| Rate for Payer: Heritage Provider Network Senior |
$100.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.85
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.16 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$234.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$301.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$329.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.54
|
| Rate for Payer: Blue Shield of California Commercial |
$84.49
|
| Rate for Payer: Blue Shield of California EPN |
$84.49
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.15
|
| Rate for Payer: Dignity Health Senior |
$373.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.26
|
| Rate for Payer: Heritage Provider Network Senior |
$203.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.30
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.60
|
| Rate for Payer: TriValley Medical Group Senior |
$175.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.15
|
| Rate for Payer: Vantage Medical Group Senior |
$373.15
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Cash Price |
$241.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.26
|
| Rate for Payer: Heritage Provider Network Senior |
$203.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.35
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$80.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.39
|
| Rate for Payer: Blue Shield of California Commercial |
$71.37
|
| Rate for Payer: Blue Shield of California EPN |
$57.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.42
|
| Rate for Payer: Heritage Provider Network Senior |
$72.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$236.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$236.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Blue Shield of California Commercial |
$31.73
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Senior |
$273.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.02
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC RIBS BILATERAL
|
Facility
|
IP
|
$914.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC RIBS BILATERAL
|
Facility
|
OP
|
$914.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.96 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$488.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.33
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Cash Price |
$502.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC RIBS UNILATERAL
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC RIBS UNILATERAL
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.72
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.73
|
| Rate for Payer: Heritage Provider Network Senior |
$453.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$10,577.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,914.44 |
| Max. Negotiated Rate |
$7,932.75 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
|
|
HC RIGHT HEART CATH
|
Facility
|
IP
|
$12,625.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,285.12 |
| Max. Negotiated Rate |
$9,468.75 |
| Rate for Payer: Adventist Health Commercial |
$2,525.00
|
| Rate for Payer: Cash Price |
$6,943.75
|
| Rate for Payer: Cash Price |
$6,943.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,285.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,156.25
|
| Rate for Payer: Multiplan Commercial |
$9,468.75
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$12,625.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$2,525.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,673.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$6,943.75
|
| Rate for Payer: Cash Price |
$6,943.75
|
| Rate for Payer: Cash Price |
$6,943.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,206.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,814.88
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,131.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,285.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,156.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$9,468.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGHT HEART CATH
|
Facility
|
OP
|
$10,577.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,150.00 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,266.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,875.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,547.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,131.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,848.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,848.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,459.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,332.24
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Senior |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,365.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,459.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,332.24
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Senior |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,911.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,911.00
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,365.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,365.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
|
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Cash Price |
$1,501.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,848.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,848.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
OP
|
$827.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$702.95 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$442.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.91
|
| Rate for Payer: Heritage Provider Network Senior |
$511.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$394.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$413.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$413.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
|
IP
|
$827.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC RLCJ SKIN POCKET CCM DFIB PG
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
CPT 0925T
|
| Hospital Charge Code |
906811513
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,056.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,627.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| 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 |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,432.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,268.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,858.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,416.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$3,960.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,556.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,324.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC RLCJ SKIN POCKET CCM DFIB PG
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
CPT 0925T
|
| Hospital Charge Code |
906811513
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$955.68 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,056.00
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.00
|
| Rate for Payer: Multiplan Commercial |
$3,960.00
|
|
