|
HC ANGIOGRAPH SPINAL
|
Facility
OP
|
$10,601.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$329.72 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,120.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$394.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,282.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| 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 |
$4,770.45
|
| Rate for Payer: Cash Price |
$4,770.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,890.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,890.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,562.02
|
| Rate for Payer: Heritage Provider Network Senior |
$6,562.02
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$329.72
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$7,950.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH SPINAL
|
Facility
IP
|
$10,601.00
|
|
|
Service Code
|
CPT 75705
|
| Hospital Charge Code |
909081617
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,918.78 |
| Max. Negotiated Rate |
$7,950.75 |
| Rate for Payer: Adventist Health Commercial |
$2,120.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,282.89
|
| Rate for Payer: Cash Price |
$4,770.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,176.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7,176.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,918.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,650.25
|
| Rate for Payer: Multiplan Commercial |
$7,950.75
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
IP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,552.46 |
| Max. Negotiated Rate |
$10,576.50 |
| Rate for Payer: Adventist Health Commercial |
$2,820.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,688.07
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,547.05
|
| Rate for Payer: Heritage Provider Network Senior |
$9,547.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.50
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
OP
|
$14,102.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
906820192
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,820.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,688.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cash Price |
$6,345.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,166.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,166.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,729.14
|
| Rate for Payer: Heritage Provider Network Senior |
$8,729.14
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$203.21
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$10,576.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
OP
|
$11,264.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$203.21 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,252.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,738.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,000.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,321.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,321.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,972.42
|
| Rate for Payer: Heritage Provider Network Senior |
$6,972.42
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$203.21
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,816.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ANGIOGRAPH VISCERAL BASIC
|
Facility
IP
|
$11,264.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
909081622
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,038.78 |
| Max. Negotiated Rate |
$8,448.00 |
| Rate for Payer: Adventist Health Commercial |
$2,252.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,738.37
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,625.73
|
| Rate for Payer: Heritage Provider Network Senior |
$7,625.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,816.00
|
| Rate for Payer: Multiplan Commercial |
$8,448.00
|
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$765.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$495.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$558.90
|
| Rate for Payer: Blue Shield of California EPN |
$528.30
|
| Rate for Payer: Cash Price |
$405.00
|
| 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 |
$433.80
|
| 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
|
| 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: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Cash Price |
$405.00
|
| 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
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| 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 |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| 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 |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,006.02
|
| Rate for Payer: Blue Shield of California EPN |
$950.94
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| 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: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$590.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$541.24
|
| 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 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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 |
$1,990.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,990.38
|
| 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 |
$1,071.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.25
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$2,499.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,617.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,205.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,825.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,725.78
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| 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: Multiplan Commercial |
$2,205.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,071.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$982.25
|
| 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 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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,147.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,012.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$838.35
|
| Rate for Payer: Blue Shield of California EPN |
$792.45
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| 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: Multiplan Commercial |
$1,012.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$492.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,147.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,147.50
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| 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 |
$913.95
|
| Rate for Payer: Heritage Provider Network Senior |
$913.95
|
| 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 |
$492.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$451.04
|
|
|
HC ANGIO LV/OR LA
|
Facility
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$397.11 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| 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 |
$397.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
|
|
HC ANGIO LV/OR LA
|
Facility
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906820071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| 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 |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Senior |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,426.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,358.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,358.09
|
| Rate for Payer: IEHP Medi-Cal |
$56.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,057.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC ANGIO LV/OR LA
|
Facility
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| 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 |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC ANGIO LV/OR LA
|
Facility
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 93565
|
| Hospital Charge Code |
906811414
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,626.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,052.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,434.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,626.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,626.05
|
| Rate for Payer: Dignity Health Senior |
$1,626.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,243.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: IEHP Medi-Cal |
$56.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$922.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,626.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,626.05
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| 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 |
$1,035.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,035.81
|
| 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 |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$950.13
|
| Rate for Payer: Blue Shield of California EPN |
$898.11
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| 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: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$557.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$511.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
IP
|
$8,332.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,508.09 |
| Max. Negotiated Rate |
$6,249.00 |
| Rate for Payer: Adventist Health Commercial |
$1,666.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,724.08
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,640.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5,640.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$6,249.00
|
|
|
HC ANGIOPLASTY INTRACRANIAL
|
Facility
OP
|
$8,332.00
|
|
|
Service Code
|
CPT 61630
|
| Hospital Charge Code |
909081013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,508.09 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,666.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,724.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,082.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,582.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,249.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$3,749.40
|
| Rate for Payer: Cash Price |
$3,749.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,415.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,082.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,082.20
|
| Rate for Payer: Dignity Health Senior |
$7,082.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,999.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,157.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,157.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,016.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,508.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,083.00
|
| Rate for Payer: Multiplan Commercial |
$6,249.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,082.20
|
| Rate for Payer: Vantage Medical Group Senior |
$7,082.20
|
|
|
HC ANGIO RV/OR RA
|
Facility
OP
|
$1,793.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$358.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,524.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$986.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,524.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,524.05
|
| Rate for Payer: Dignity Health Senior |
$1,524.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,165.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,109.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,109.87
|
| Rate for Payer: IEHP Medi-Cal |
$241.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$864.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.25
|
| Rate for Payer: Multiplan Commercial |
$1,344.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,524.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,524.05
|
|
|
HC ANGIO RV/OR RA
|
Facility
IP
|
$1,793.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906811415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$324.53 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$358.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.79
|
| Rate for Payer: Cash Price |
$806.85
|
| Rate for Payer: Cash Price |
$806.85
|
| 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 |
$324.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.25
|
| Rate for Payer: Multiplan Commercial |
$1,344.75
|
|
|
HC ANGIO RV/OR RA
|
Facility
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
906820072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$241.32 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,402.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,662.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,075.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,467.00
|
| 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 |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,662.60
|
| Rate for Payer: Dignity Health Senior |
$1,662.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,271.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,210.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,210.76
|
| Rate for Payer: IEHP Medi-Cal |
$241.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$942.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,662.60
|
|
