|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
IP
|
$944.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.09
|
| Rate for Payer: Heritage Provider Network Senior |
$639.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
OP
|
$944.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$504.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Blue Shield of California Commercial |
$586.22
|
| Rate for Payer: Blue Shield of California EPN |
$554.13
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$613.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Senior |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.34
|
| Rate for Payer: Heritage Provider Network Senior |
$584.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$455.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$807.98 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,022.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,022.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$3,794.40 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$314.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,455.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,348.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,901.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,794.40
|
| Rate for Payer: Dignity Health Senior |
$3,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,901.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,763.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,763.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,794.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,794.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$3,000.86 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$314.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,068.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,338.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,824.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,068.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,068.05
|
| Rate for Payer: Dignity Health Senior |
$2,068.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,581.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,506.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,506.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,172.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,068.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.05
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$2,433.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$440.37 |
| Max. Negotiated Rate |
$1,824.75 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.47
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,647.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,647.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,170.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$634.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,177.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,694.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,743.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,694.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,694.50
|
| Rate for Payer: Dignity Health Senior |
$2,694.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,962.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,962.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,527.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.50
|
| Rate for Payer: Multiplan Commercial |
$2,377.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,694.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,694.50
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$577.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$637.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,190.16
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| 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 |
$577.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,391.00
|
|
|
HC ANGIO CORONARY
|
Facility
|
OP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$637.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,190.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,753.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,391.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,709.80
|
| Rate for Payer: Dignity Health Senior |
$2,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,072.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,973.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,973.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,536.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,391.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,709.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,709.80
|
|
|
HC ANGIO CORONARY
|
Facility
|
IP
|
$3,170.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$634.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,177.79
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| 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 |
$573.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.50
|
| Rate for Payer: Multiplan Commercial |
$2,377.50
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$241.47 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
IP
|
$7,502.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,357.86 |
| Max. Negotiated Rate |
$5,626.50 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,153.87
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,078.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5,078.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.50
|
| Rate for Payer: Multiplan Commercial |
$5,626.50
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
|
OP
|
$7,502.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$217.57 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$395.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,153.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,876.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,876.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,643.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4,643.74
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,626.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,871.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,755.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: Dignity Health Senior |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,099.28
|
| Rate for Payer: Heritage Provider Network Senior |
$13,099.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,200.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC ANGIOGRAPH EXT CAROTID UNILAT
|
Facility
|
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909081608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,830.32 |
| Max. Negotiated Rate |
$15,871.50 |
| Rate for Payer: Adventist Health Commercial |
$4,232.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,538.29
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,326.67
|
| Rate for Payer: Heritage Provider Network Senior |
$14,326.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,290.50
|
| Rate for Payer: Multiplan Commercial |
$15,871.50
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$13,136.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,377.62 |
| Max. Negotiated Rate |
$9,852.00 |
| Rate for Payer: Adventist Health Commercial |
$2,627.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,024.43
|
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,893.07
|
| Rate for Payer: Heritage Provider Network Senior |
$8,893.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,377.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,284.00
|
| Rate for Payer: Multiplan Commercial |
$9,852.00
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$229.30 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$454.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$229.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
909081619
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH EXTREMITY BILAT
|
Facility
|
OP
|
$13,136.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
906820191
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$229.30 |
| Max. Negotiated Rate |
$9,852.00 |
| Rate for Payer: Adventist Health Commercial |
$2,627.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$454.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,024.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: Cash Price |
$5,911.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,538.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,538.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,131.18
|
| Rate for Payer: Heritage Provider Network Senior |
$8,131.18
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$229.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,377.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$9,852.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$11,282.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$8,461.50 |
| Rate for Payer: Adventist Health Commercial |
$2,256.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$395.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,750.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,333.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,333.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,983.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,983.56
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,042.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$8,461.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$11,282.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
906820184
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,042.04 |
| Max. Negotiated Rate |
$8,461.50 |
| Rate for Payer: Adventist Health Commercial |
$2,256.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,750.73
|
| Rate for Payer: Cash Price |
$5,076.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,637.91
|
| Rate for Payer: Heritage Provider Network Senior |
$7,637.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,042.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,820.50
|
| Rate for Payer: Multiplan Commercial |
$8,461.50
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$395.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH EXTREMITY UNILAT
|
Facility
|
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
909081572
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH INTERNAL MAMMARY
|
Facility
|
IP
|
$4,223.00
|
|
|
Service Code
|
CPT 75756
|
| Hospital Charge Code |
909081576
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$764.36 |
| Max. Negotiated Rate |
$3,167.25 |
| Rate for Payer: Adventist Health Commercial |
$844.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,901.20
|
| Rate for Payer: Cash Price |
$1,900.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,858.97
|
| Rate for Payer: Heritage Provider Network Senior |
$2,858.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$764.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.75
|
| Rate for Payer: Multiplan Commercial |
$3,167.25
|
|
