|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.30 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$972.79
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$958.63
|
| Rate for Payer: Heritage Provider Network Senior |
$958.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
906820175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$972.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$778.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,062.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$920.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,203.60
|
| Rate for Payer: Dignity Health Senior |
$1,203.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$876.50
|
| Rate for Payer: Heritage Provider Network Senior |
$876.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$682.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$1,062.00
|
| 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 |
$1,203.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,203.60
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,028.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,402.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,215.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,589.50
|
| Rate for Payer: Dignity Health Senior |
$1,589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,157.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,157.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$901.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.50
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
| 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 |
$1,589.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,589.50
|
|
|
HC AORTA CATHETER (FEMORAL/AX
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
909081318
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.47 |
| Max. Negotiated Rate |
$1,402.50 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.69
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,265.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,265.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.50
|
| Rate for Payer: Multiplan Commercial |
$1,402.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$457.93 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$506.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,738.11
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| 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 |
$457.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.50
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$2,530.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906820073
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$145.39 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$506.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,738.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,897.50
|
| 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 |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.50
|
| Rate for Payer: Dignity Health Senior |
$2,150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,644.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,566.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,219.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.50
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| 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 |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,150.50
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
IP
|
$1,761.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$318.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,209.81
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| 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 |
$318.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.25
|
| Rate for Payer: Multiplan Commercial |
$1,320.75
|
|
|
HC AORTOGRAM/SUPRAVALVULAR
|
Facility
|
OP
|
$1,761.00
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
906811416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$145.39 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$352.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,209.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,320.75
|
| 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 |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cash Price |
$792.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.85
|
| Rate for Payer: Dignity Health Senior |
$1,496.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,090.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,090.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$848.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.25
|
| Rate for Payer: Multiplan Commercial |
$1,320.75
|
| 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 |
$1,496.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.85
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$7,382.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$179.37 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,071.43
|
| 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 |
$3,000.97
|
| 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 |
$3,321.90
|
| Rate for Payer: Cash Price |
$3,321.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,798.30
|
| 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 |
$4,798.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,569.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,569.46
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.37
|
| 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 |
$1,336.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.50
|
| 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 |
$5,536.50
|
| 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 AORTOGRAPH ABDOMINAL
|
Facility
|
OP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$179.37 |
| Max. Negotiated Rate |
$9,741.00 |
| Rate for Payer: Adventist Health Commercial |
$2,597.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$351.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,922.76
|
| 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 |
$5,844.60
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,442.20
|
| 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 |
$8,442.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,039.57
|
| Rate for Payer: Heritage Provider Network Senior |
$8,039.57
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.37
|
| 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 |
$2,350.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.00
|
| 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 |
$9,741.00
|
| 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 AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$12,988.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
906820189
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,350.83 |
| Max. Negotiated Rate |
$9,741.00 |
| Rate for Payer: Adventist Health Commercial |
$2,597.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,922.76
|
| Rate for Payer: Cash Price |
$5,844.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,792.88
|
| Rate for Payer: Heritage Provider Network Senior |
$8,792.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,350.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.00
|
| Rate for Payer: Multiplan Commercial |
$9,741.00
|
|
|
HC AORTOGRAPH ABDOMINAL
|
Facility
|
IP
|
$7,382.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
909081602
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,336.14 |
| Max. Negotiated Rate |
$5,536.50 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,071.43
|
| Rate for Payer: Cash Price |
$3,321.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,997.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,997.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,336.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.50
|
| Rate for Payer: Multiplan Commercial |
$5,536.50
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$7,382.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$221.86 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$360.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,071.43
|
| 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 |
$3,127.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,679.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.72
|
| Rate for Payer: Cash Price |
$3,321.90
|
| Rate for Payer: Cash Price |
$3,321.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,798.30
|
| 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 |
$4,798.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,569.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,569.46
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.86
|
| 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 |
$1,336.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.50
|
| 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 |
$5,536.50
|
| 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 AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,594.82 |
| Max. Negotiated Rate |
$10,752.00 |
| Rate for Payer: Adventist Health Commercial |
$2,867.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,848.83
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,705.47
|
| Rate for Payer: Heritage Provider Network Senior |
$9,705.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,594.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.00
|
| Rate for Payer: Multiplan Commercial |
$10,752.00
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
IP
|
$7,382.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
909081603
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,336.14 |
| Max. Negotiated Rate |
$5,536.50 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,071.43
|
| Rate for Payer: Cash Price |
$3,321.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,997.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,997.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,336.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,845.50
|
| Rate for Payer: Multiplan Commercial |
$5,536.50
|
|
|
HC AORTOGRAPH ABDOMINAL AIF
|
Facility
|
OP
|
$14,336.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
906820190
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$221.86 |
| Max. Negotiated Rate |
$10,752.00 |
| Rate for Payer: Adventist Health Commercial |
$2,867.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$360.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,848.83
|
| 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 |
$3,127.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,679.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,523.72
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cash Price |
$6,451.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,318.40
|
| 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 |
$9,318.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,873.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8,873.98
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.86
|
| 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 |
$2,594.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,584.00
|
| 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 |
$10,752.00
|
| 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 AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$172.46 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,342.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$350.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,046.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| 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 |
$5,270.85
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,613.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,613.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,250.35
|
| Rate for Payer: Heritage Provider Network Senior |
$7,250.35
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,713.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
906820188
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,120.05 |
| Max. Negotiated Rate |
$8,784.75 |
| Rate for Payer: Adventist Health Commercial |
$2,342.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,046.83
|
| Rate for Payer: Cash Price |
$5,270.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,929.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,929.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,120.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,928.25
|
| Rate for Payer: Multiplan Commercial |
$8,784.75
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
IP
|
$11,072.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,004.03 |
| Max. Negotiated Rate |
$8,304.00 |
| Rate for Payer: Adventist Health Commercial |
$2,214.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,606.46
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,495.74
|
| Rate for Payer: Heritage Provider Network Senior |
$7,495.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,004.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,768.00
|
| Rate for Payer: Multiplan Commercial |
$8,304.00
|
|
|
HC AORTOGRAPH THORACIC
|
Facility
|
OP
|
$11,072.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
909081600
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$172.46 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,214.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$350.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,606.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| 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 |
$4,982.40
|
| Rate for Payer: Cash Price |
$4,982.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,196.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,196.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,853.57
|
| Rate for Payer: Heritage Provider Network Senior |
$6,853.57
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$172.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,004.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,768.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,304.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| 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 |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$637.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$552.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$722.50
|
| Rate for Payer: Dignity Health Senior |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$526.15
|
| Rate for Payer: Heritage Provider Network Senior |
$526.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$409.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| 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 |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.36 |
| Max. Negotiated Rate |
$2,007.00 |
| Rate for Payer: Adventist Health Commercial |
$535.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,838.41
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,811.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,811.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.00
|
| Rate for Payer: Multiplan Commercial |
$2,007.00
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
906820174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.95
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.45
|
| Rate for Payer: Heritage Provider Network Senior |
$575.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
|
|
HC AORTO TRNSLMBR NEEDL/CATH
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
909081317
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$535.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,838.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,274.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,471.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,007.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,739.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,274.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.60
|
| Rate for Payer: Dignity Health Senior |
$2,274.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,656.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,656.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,289.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.00
|
| Rate for Payer: Multiplan Commercial |
$2,007.00
|
| 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 |
$2,274.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,274.60
|
|
|
HC APLS IGA
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Adventist Health Commercial |
$11.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.27
|
| Rate for Payer: Heritage Provider Network Senior |
$39.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.50
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
|
