|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.10
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Senior |
$280.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
HC AST
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC AST
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.36
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.36
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| 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 |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| 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 |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.70 |
| Max. Negotiated Rate |
$1,069.30 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$672.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$864.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,069.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$943.50
|
| Rate for Payer: Blue Shield of California Commercial |
$781.22
|
| Rate for Payer: Blue Shield of California EPN |
$738.45
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,069.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,069.30
|
| Rate for Payer: Dignity Health Senior |
$1,069.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$817.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$778.70
|
| Rate for Payer: Heritage Provider Network Senior |
$778.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$606.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.50
|
| Rate for Payer: Multiplan Commercial |
$943.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,069.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,069.30
|
|
|
HC ATHERECTOMY, EA ADD VISCERAL
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 75996
|
| Hospital Charge Code |
909080035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.70 |
| Max. Negotiated Rate |
$943.50 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$864.25
|
| Rate for Payer: Cash Price |
$566.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$851.67
|
| Rate for Payer: Heritage Provider Network Senior |
$851.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.50
|
| Rate for Payer: Multiplan Commercial |
$943.50
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY ILIAC
|
Facility
|
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| 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 |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$1,886.25 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
|
|
HC ATHERECTOMY, RENAL
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 75994
|
| Hospital Charge Code |
909080033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,344.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,383.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,886.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,476.30
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,634.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,137.75
|
| Rate for Payer: Dignity Health Senior |
$2,137.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,634.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,556.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,556.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,212.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,137.75
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
IP
|
$25,902.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$19,426.50 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,535.65
|
| Rate for Payer: Heritage Provider Network Senior |
$17,535.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
|
|
HC ATHERECTOMY RENAL OR VISCERAL
|
Facility
|
OP
|
$25,902.00
|
|
| Hospital Charge Code |
909080028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,688.26 |
| Max. Negotiated Rate |
$22,016.70 |
| Rate for Payer: Adventist Health Commercial |
$5,180.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,794.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,246.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,426.50
|
| 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 |
$11,655.90
|
| Rate for Payer: Cash Price |
$11,655.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,836.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,016.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,016.70
|
| Rate for Payer: Dignity Health Senior |
$22,016.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,033.34
|
| Rate for Payer: Heritage Provider Network Senior |
$16,033.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,484.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,688.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,475.50
|
| Rate for Payer: Multiplan Commercial |
$19,426.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,016.70
|
| Rate for Payer: Vantage Medical Group Senior |
$22,016.70
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$1,886.25 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
|
|
HC ATHERECTOMY, VISCERAL
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 75995
|
| Hospital Charge Code |
909080034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,344.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,383.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,886.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,561.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,476.30
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,634.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,137.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,137.75
|
| Rate for Payer: Dignity Health Senior |
$2,137.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,634.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,556.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,556.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,212.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,137.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,137.75
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906820259
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$26,346.75 |
| Rate for Payer: Adventist Health Commercial |
$7,025.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,133.62
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| 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 |
$6,358.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.25
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906811438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,359.90 |
| Max. Negotiated Rate |
$13,922.25 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,435.95 |
| Max. Negotiated Rate |
$18,381.00 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| 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 |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
IP
|
$53,259.00
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
906820241
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$39,944.25 |
| Rate for Payer: Adventist Health Commercial |
$10,651.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,588.93
|
| Rate for Payer: Cash Price |
$23,966.55
|
| Rate for Payer: Cash Price |
$23,966.55
|
| 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 |
$9,639.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,314.75
|
| Rate for Payer: Multiplan Commercial |
$39,944.25
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906820259
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,025.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,271.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,133.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,833.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,833.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,744.85
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,358.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHERECTOMY W CORONARY STENT
|
Facility
|
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
906811461
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,271.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,930.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,930.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,170.45
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
