|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
OP
|
$638.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$542.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$350.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$478.50
|
| Rate for Payer: Blue Shield of California Commercial |
$396.20
|
| Rate for Payer: Blue Shield of California EPN |
$374.51
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$542.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.30
|
| Rate for Payer: Dignity Health Senior |
$542.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Vantage Medical Group Senior |
$542.30
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
IP
|
$638.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
OP
|
$5,042.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$912.60 |
| Max. Negotiated Rate |
$4,285.70 |
| Rate for Payer: Adventist Health Commercial |
$1,008.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,694.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,463.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,285.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,773.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,781.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,131.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,959.65
|
| Rate for Payer: Cash Price |
$2,268.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,277.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,285.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,285.70
|
| Rate for Payer: Dignity Health Senior |
$4,285.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,277.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,121.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,430.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$3,781.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,285.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,285.70
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
IP
|
$5,042.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$912.60 |
| Max. Negotiated Rate |
$3,781.50 |
| Rate for Payer: Adventist Health Commercial |
$1,008.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,463.85
|
| Rate for Payer: Cash Price |
$2,268.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,413.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,413.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$3,781.50
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
OP
|
$885.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$473.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$752.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$486.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$663.75
|
| Rate for Payer: Blue Shield of California Commercial |
$549.58
|
| Rate for Payer: Blue Shield of California EPN |
$519.50
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$575.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$752.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.25
|
| Rate for Payer: Dignity Health Senior |
$752.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$575.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.82
|
| Rate for Payer: Heritage Provider Network Senior |
$547.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$426.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.25
|
| Rate for Payer: Vantage Medical Group Senior |
$752.25
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
IP
|
$885.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$160.18 |
| Max. Negotiated Rate |
$663.75 |
| Rate for Payer: Adventist Health Commercial |
$177.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.00
|
| Rate for Payer: Cash Price |
$398.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.14
|
| Rate for Payer: Heritage Provider Network Senior |
$599.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.25
|
| Rate for Payer: Multiplan Commercial |
$663.75
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
OP
|
$6,286.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,137.77 |
| Max. Negotiated Rate |
$5,343.10 |
| Rate for Payer: Adventist Health Commercial |
$1,257.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,359.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,318.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,343.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,457.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,714.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,903.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,689.88
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,085.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,343.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,343.10
|
| Rate for Payer: Dignity Health Senior |
$5,343.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,085.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,891.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,891.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,137.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$4,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,343.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,343.10
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
IP
|
$6,286.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,137.77 |
| Max. Negotiated Rate |
$4,714.50 |
| Rate for Payer: Adventist Health Commercial |
$1,257.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,318.48
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,255.62
|
| Rate for Payer: Heritage Provider Network Senior |
$4,255.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,137.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.50
|
| Rate for Payer: Multiplan Commercial |
$4,714.50
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
OP
|
$1,130.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$603.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$847.50
|
| Rate for Payer: Blue Shield of California Commercial |
$701.73
|
| Rate for Payer: Blue Shield of California EPN |
$663.31
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$734.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: Dignity Health Senior |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$734.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$699.47
|
| Rate for Payer: Heritage Provider Network Senior |
$699.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$544.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
IP
|
$1,130.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$847.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.31
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$765.01
|
| Rate for Payer: Heritage Provider Network Senior |
$765.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
IP
|
$5,102.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$923.46 |
| Max. Negotiated Rate |
$3,826.50 |
| Rate for Payer: Adventist Health Commercial |
$1,020.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,505.07
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,454.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,454.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.50
|
| Rate for Payer: Multiplan Commercial |
$3,826.50
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
OP
|
$5,102.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$923.46 |
| Max. Negotiated Rate |
$4,336.70 |
| Rate for Payer: Adventist Health Commercial |
$1,020.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,727.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,505.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,336.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,806.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,826.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,168.34
|
| Rate for Payer: Blue Shield of California EPN |
$2,994.87
|
| Rate for Payer: Cash Price |
$2,295.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,316.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,336.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,336.70
|
| Rate for Payer: Dignity Health Senior |
$4,336.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,316.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,158.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3,158.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,459.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.50
|
| Rate for Payer: Multiplan Commercial |
$3,826.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,336.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,336.70
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
OP
|
$944.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$802.40 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$504.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$802.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$519.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$708.00
|
| Rate for Payer: Blue Shield of California Commercial |
$586.22
|
| Rate for Payer: Blue Shield of California EPN |
$554.13
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$613.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.40
|
| Rate for Payer: Dignity Health Senior |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.34
|
| Rate for Payer: Heritage Provider Network Senior |
$584.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$455.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.40
|
| Rate for Payer: Vantage Medical Group Senior |
$802.40
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
IP
|
$944.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$170.86 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Adventist Health Commercial |
$188.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.53
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$639.09
|
| Rate for Payer: Heritage Provider Network Senior |
$639.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
IP
|
$2,433.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$440.37 |
| Max. Negotiated Rate |
$1,824.75 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.47
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,647.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,647.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
IP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$807.98 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,022.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,022.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
OP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$3,794.40 |
| Rate for Payer: Adventist Health Commercial |
$892.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$314.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,066.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,794.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,455.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,348.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,901.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,794.40
|
| Rate for Payer: Dignity Health Senior |
$3,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,901.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,763.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,763.22
|
| Rate for Payer: IEHP Medi-Cal |
$117.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.00
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,794.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,794.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
OP
|
$2,433.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$3,000.86 |
| Rate for Payer: Adventist Health Commercial |
$486.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$314.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,671.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,068.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,338.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,824.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cash Price |
$1,094.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,581.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,068.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,068.05
|
| Rate for Payer: Dignity Health Senior |
$2,068.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,581.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,506.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,506.03
|
| Rate for Payer: IEHP Medi-Cal |
$117.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,172.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.25
|
| Rate for Payer: Multiplan Commercial |
$1,824.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,068.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.05
|
|
|
HC ANGIO CORONARY
|
Facility
IP
|
$3,170.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$573.77 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$634.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,177.79
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.50
|
| Rate for Payer: Multiplan Commercial |
$2,377.50
|
|
|
HC ANGIO CORONARY
|
Facility
OP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$637.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,190.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,709.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,753.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,391.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,709.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,709.80
|
| Rate for Payer: Dignity Health Senior |
$2,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,072.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,973.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,973.37
|
| Rate for Payer: IEHP Medi-Cal |
$73.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,536.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,391.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,709.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,709.80
|
|
|
HC ANGIO CORONARY
|
Facility
IP
|
$3,188.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906820069
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$577.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$637.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,190.16
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Cash Price |
$1,434.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,391.00
|
|
|
HC ANGIO CORONARY
|
Facility
OP
|
$3,170.00
|
|
|
Service Code
|
CPT 93563
|
| Hospital Charge Code |
906811412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$634.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,177.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,694.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,743.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cash Price |
$1,426.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,694.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,694.50
|
| Rate for Payer: Dignity Health Senior |
$2,694.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,060.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,962.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,962.23
|
| Rate for Payer: IEHP Medi-Cal |
$73.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,527.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$792.50
|
| Rate for Payer: Multiplan Commercial |
$2,377.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,694.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,694.50
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ANGIOGRAPH ADRENAL BILAT
|
Facility
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75733
|
| Hospital Charge Code |
909081624
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$241.47 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$453.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$241.47
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ANGIOGRAPH ADRENAL UNILAT
|
Facility
IP
|
$7,502.00
|
|
|
Service Code
|
CPT 75731
|
| Hospital Charge Code |
909081574
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,357.86 |
| Max. Negotiated Rate |
$5,626.50 |
| Rate for Payer: Adventist Health Commercial |
$1,500.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,153.87
|
| Rate for Payer: Cash Price |
$3,375.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,078.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5,078.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,357.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,875.50
|
| Rate for Payer: Multiplan Commercial |
$5,626.50
|
|
