|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$690.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$887.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Blue Shield of California Commercial |
$788.12
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Senior |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$839.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$799.75
|
| Rate for Payer: Heritage Provider Network Senior |
$799.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$616.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$646.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$646.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
OP
|
$996.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$180.28 |
| Max. Negotiated Rate |
$846.60 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$532.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$747.00
|
| Rate for Payer: Blue Shield of California Commercial |
$607.56
|
| Rate for Payer: Blue Shield of California EPN |
$486.05
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$647.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$846.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$846.60
|
| Rate for Payer: Dignity Health Senior |
$846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$647.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.52
|
| Rate for Payer: Heritage Provider Network Senior |
$616.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$498.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$498.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$846.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$846.60
|
| Rate for Payer: Vantage Medical Group Senior |
$846.60
|
|
|
HC SEDATION LT 5 YRS FIRST 30 MIN
|
Facility
|
IP
|
$996.00
|
|
| Hospital Charge Code |
906820140
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$180.28 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$674.29
|
| Rate for Payer: Heritage Provider Network Senior |
$674.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.20
|
| Rate for Payer: Heritage Provider Network Senior |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.39
|
| Rate for Payer: Blue Shield of California Commercial |
$28.57
|
| Rate for Payer: Blue Shield of California EPN |
$22.92
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cash Price |
$81.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.61
|
| Rate for Payer: Heritage Provider Network Senior |
$91.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$68.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.85
|
| Rate for Payer: Blue Shield of California Commercial |
$21.72
|
| Rate for Payer: Blue Shield of California EPN |
$17.42
|
| Rate for Payer: Cash Price |
$68.75
|
| Rate for Payer: Cash Price |
$68.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Senior |
$2.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.70
|
| Rate for Payer: TriValley Medical Group Senior |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
OP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$443.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.50
|
| Rate for Payer: Blue Shield of California Commercial |
$506.30
|
| Rate for Payer: Blue Shield of California EPN |
$405.04
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$539.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: Dignity Health Senior |
$705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.77
|
| Rate for Payer: Heritage Provider Network Senior |
$513.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$395.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$415.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$415.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
IP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.23 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$456.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$561.91
|
| Rate for Payer: Heritage Provider Network Senior |
$561.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.50
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.54
|
| Rate for Payer: Heritage Provider Network Senior |
$319.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Senior |
$401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.17
|
| Rate for Payer: Heritage Provider Network Senior |
$292.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
906820171
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
906820171
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$471.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$471.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$471.75
|
| Rate for Payer: Dignity Health Senior |
$471.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.55
|
| Rate for Payer: Heritage Provider Network Senior |
$343.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$264.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$388.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$471.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$471.75
|
| Rate for Payer: Vantage Medical Group Senior |
$471.75
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$319.54
|
| Rate for Payer: Heritage Provider Network Senior |
$319.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
906820172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$471.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$471.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$471.75
|
| Rate for Payer: Dignity Health Senior |
$471.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.55
|
| Rate for Payer: Heritage Provider Network Senior |
$343.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$264.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$388.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$471.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$471.75
|
| Rate for Payer: Vantage Medical Group Senior |
$471.75
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cash Price |
$259.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Senior |
$401.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.17
|
| Rate for Payer: Heritage Provider Network Senior |
$292.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
906820172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
|
|
HC SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$216.60
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$733.19
|
| Rate for Payer: Heritage Provider Network Senior |
$733.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
|
|
HC SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$812.25 |
| Rate for Payer: Adventist Health Commercial |
$444.03
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$744.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cash Price |
$595.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$670.38
|
| Rate for Payer: Heritage Provider Network Senior |
$670.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$516.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$812.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$243.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$504.05 |
| Rate for Payer: Adventist Health Commercial |
$243.13
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$444.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$504.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$504.05
|
| Rate for Payer: Dignity Health Senior |
$504.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.07
|
| Rate for Payer: Heritage Provider Network Senior |
$367.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$415.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$415.10
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$504.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$504.05
|
| Rate for Payer: Vantage Medical Group Senior |
$504.05
|
|
