|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
906820157
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,814.78 |
| Max. Negotiated Rate |
$19,950.75 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,008.88
|
| Rate for Payer: Heritage Provider Network Senior |
$18,008.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
906820157
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22,610.85 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,274.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,610.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,630.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,950.75
|
| 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 |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cash Price |
$14,630.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,290.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,610.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,610.85
|
| Rate for Payer: Dignity Health Senior |
$22,610.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,466.02
|
| Rate for Payer: Heritage Provider Network Senior |
$16,466.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,688.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,620.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,620.70
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,610.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,610.85
|
| Rate for Payer: Vantage Medical Group Senior |
$22,610.85
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,078.25 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,419.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,344.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,833.75
|
| 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 |
$12,344.75
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,589.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,078.25
|
| Rate for Payer: Dignity Health Senior |
$19,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,893.45
|
| Rate for Payer: Heritage Provider Network Senior |
$13,893.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,706.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,062.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,711.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,711.50
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,078.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19,078.25
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
IP
|
$22,445.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$16,833.75 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Cash Price |
$12,344.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,062.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,611.25
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
IP
|
$42,308.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,657.75 |
| Max. Negotiated Rate |
$31,731.00 |
| Rate for Payer: Adventist Health Commercial |
$8,461.60
|
| Rate for Payer: Cash Price |
$23,269.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$28,642.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,657.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,577.00
|
| Rate for Payer: Multiplan Commercial |
$31,731.00
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
OP
|
$30,748.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
906820161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$26,135.80 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,123.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,135.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,911.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,061.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$16,911.40
|
| Rate for Payer: Cash Price |
$16,911.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,986.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,135.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,135.80
|
| Rate for Payer: Dignity Health Senior |
$26,135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,448.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,033.01
|
| Rate for Payer: Heritage Provider Network Senior |
$19,033.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,666.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,523.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,523.60
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,135.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,135.80
|
| Rate for Payer: Vantage Medical Group Senior |
$26,135.80
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
IP
|
$30,748.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
906820161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,565.39 |
| Max. Negotiated Rate |
$23,061.00 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Cash Price |
$16,911.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,816.40
|
| Rate for Payer: Heritage Provider Network Senior |
$20,816.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
OP
|
$42,308.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$35,961.80 |
| Rate for Payer: Adventist Health Commercial |
$8,461.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,065.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,961.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23,269.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31,731.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$23,269.40
|
| Rate for Payer: Cash Price |
$23,269.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27,500.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,961.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$35,961.80
|
| Rate for Payer: Dignity Health Senior |
$35,961.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,384.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,188.65
|
| Rate for Payer: Heritage Provider Network Senior |
$26,188.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,180.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,657.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,577.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,615.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,615.60
|
| Rate for Payer: Multiplan Commercial |
$31,731.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,961.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35,961.80
|
| Rate for Payer: Vantage Medical Group Senior |
$35,961.80
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
OP
|
$9,939.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,016.27 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,828.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,448.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,466.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,454.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$5,466.45
|
| Rate for Payer: Cash Price |
$5,466.45
|
| Rate for Payer: Cash Price |
$5,466.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,460.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,448.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,448.15
|
| Rate for Payer: Dignity Health Senior |
$8,448.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,152.24
|
| Rate for Payer: Heritage Provider Network Senior |
$6,152.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,016.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,740.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,798.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,484.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,957.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,957.30
|
| Rate for Payer: Multiplan Commercial |
$7,454.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,448.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,448.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8,448.15
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
OP
|
$8,182.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,016.27 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,621.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,954.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,500.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$4,500.10
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,318.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,954.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,954.70
|
| Rate for Payer: Dignity Health Senior |
$6,954.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,064.66
|
| Rate for Payer: Heritage Provider Network Senior |
$5,064.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,016.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,902.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,480.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,727.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,727.40
|
| Rate for Payer: Multiplan Commercial |
$6,136.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,954.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,954.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6,954.70
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
IP
|
$9,939.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,798.96 |
| Max. Negotiated Rate |
$7,454.25 |
| Rate for Payer: Adventist Health Commercial |
$1,987.80
|
| Rate for Payer: Cash Price |
$5,466.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,728.70
|
| Rate for Payer: Heritage Provider Network Senior |
$6,728.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,798.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,484.75
|
| Rate for Payer: Multiplan Commercial |
$7,454.25
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
IP
|
$8,182.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,480.94 |
| Max. Negotiated Rate |
$6,136.50 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Cash Price |
$4,500.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,539.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,539.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,480.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.50
|
| Rate for Payer: Multiplan Commercial |
$6,136.50
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018430
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018430
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9165
|
| Hospital Charge Code |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018232
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018432
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018232
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018132
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018132
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018432
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018231
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
