|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,241.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$192.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
909081575
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Cash Price |
$3,335.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ANGIOGRAPH PULMONARY UNILAT
|
Facility
|
OP
|
$7,344.00
|
|
|
Service Code
|
CPT 75741
|
| Hospital Charge Code |
906820185
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$192.83 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$1,468.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,925.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,045.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Cash Price |
$4,039.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,773.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,773.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,545.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4,545.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$192.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,503.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,329.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,836.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$5,508.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| 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 |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,421.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,421.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
|
|
HC ANGIOGRAPH PULMONARY VENOUS INJ
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
CPT 75746
|
| Hospital Charge Code |
909081628
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$198.89 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$420.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,122.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,442.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,365.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,365.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,299.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,299.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$198.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,001.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$525.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$1,575.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
OP
|
$8,560.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$342.40 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,575.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,880.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,564.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,564.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,298.64
|
| Rate for Payer: Heritage Provider Network Senior |
$5,298.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,083.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$6,420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
|
IP
|
$8,560.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,549.36 |
| Max. Negotiated Rate |
$6,420.00 |
| Rate for Payer: Adventist Health Commercial |
$1,712.00
|
| Rate for Payer: Cash Price |
$4,708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,795.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5,795.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,140.00
|
| Rate for Payer: Multiplan Commercial |
$6,420.00
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$9,096.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| Rate for Payer: Cash Price |
$5,002.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,157.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,157.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,646.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,274.00
|
| Rate for Payer: Multiplan Commercial |
$6,822.00
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$13,397.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$2,679.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,160.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,203.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$7,368.35
|
| Rate for Payer: Cash Price |
$7,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,708.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,708.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,292.74
|
| Rate for Payer: Heritage Provider Network Senior |
$8,292.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,390.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,424.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,349.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$10,047.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
OP
|
$9,096.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,819.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,861.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,248.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$5,002.80
|
| Rate for Payer: Cash Price |
$5,002.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,912.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,912.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,630.42
|
| Rate for Payer: Heritage Provider Network Senior |
$5,630.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,338.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,646.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,274.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$6,822.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
|
IP
|
$13,397.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,424.86 |
| Max. Negotiated Rate |
$10,047.75 |
| Rate for Payer: Adventist Health Commercial |
$2,679.40
|
| Rate for Payer: Cash Price |
$7,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,069.77
|
| Rate for Payer: Heritage Provider Network Senior |
$9,069.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,424.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,349.25
|
| Rate for Payer: Multiplan Commercial |
$10,047.75
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$549.00
|
| Rate for Payer: Blue Shield of California EPN |
$439.20
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$765.00
|
| Rate for Payer: Dignity Health Senior |
$765.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$630.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$630.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$765.00
|
| Rate for Payer: Vantage Medical Group Senior |
$765.00
|
|
|
HC ANGIOJET PUMP SET
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
909080038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,112.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.24
|
| Rate for Payer: Blue Shield of California EPN |
$651.24
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Senior |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,036.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$536.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC ANGIO JET THROM CATH 105CM
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$777.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.24
|
| Rate for Payer: Blue Shield of California EPN |
$651.24
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$750.06
|
| Rate for Payer: Heritage Provider Network Senior |
$750.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$585.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$536.38
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,411.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,019.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,181.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,181.88
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,499.00
|
| Rate for Payer: Dignity Health Senior |
$2,499.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,881.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,361.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,361.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,058.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,058.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,062.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,499.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,499.00
|
|
|
HC ANGIO JET THROM CATH 140CM
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081714
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$588.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,411.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,181.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,181.88
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cash Price |
$1,617.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,352.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,587.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,361.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,361.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,470.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,062.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.43
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$648.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$542.70
|
| Rate for Payer: Blue Shield of California EPN |
$542.70
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.05
|
| Rate for Payer: Heritage Provider Network Senior |
$625.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$487.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$446.99
|
|
|
HC ANGIO JET THROM CATH 60CM
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$270.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$648.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$542.70
|
| Rate for Payer: Blue Shield of California EPN |
$542.70
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$621.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,147.50
|
| Rate for Payer: Dignity Health Senior |
$1,147.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$625.05
|
| Rate for Payer: Heritage Provider Network Senior |
$625.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$945.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$945.00
|
| Rate for Payer: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$487.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$446.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$295.39 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| 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 |
$295.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,121.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,224.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Senior |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$778.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,142.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
OP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,431.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,146.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,563.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,771.40
|
| Rate for Payer: Dignity Health Senior |
$1,771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,290.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,290.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$994.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,458.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,458.80
|
| Rate for Payer: Multiplan Commercial |
$1,563.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,771.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,771.40
|
|
|
HC ANGIO LV/OR LA
|
Facility
|
IP
|
$2,084.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$377.20 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$416.80
|
| Rate for Payer: Cash Price |
$1,146.20
|
| Rate for Payer: Cash Price |
$1,146.20
|
| 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 |
$377.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$521.00
|
| Rate for Payer: Multiplan Commercial |
$1,563.00
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Senior |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY/ENDEAVOR
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
|
