|
HC ATHRECTOMY RENAL
|
Facility
|
IP
|
$36,702.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,643.06 |
| Max. Negotiated Rate |
$27,526.50 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,636.09
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,847.25
|
| Rate for Payer: Heritage Provider Network Senior |
$24,847.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,643.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
|
|
HC ATHRECTOMY RENAL
|
Facility
|
OP
|
$36,702.00
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
909020077
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,643.06 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,681.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,856.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,021.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,718.54
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,643.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$16,332.54
|
| 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 |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
|
IP
|
$37,843.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,849.58 |
| Max. Negotiated Rate |
$28,382.25 |
| Rate for Payer: Adventist Health Commercial |
$7,568.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,370.89
|
| Rate for Payer: Cash Price |
$17,029.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,619.71
|
| Rate for Payer: Heritage Provider Network Senior |
$25,619.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,849.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,460.75
|
| Rate for Payer: Multiplan Commercial |
$28,382.25
|
|
|
HC ATHRECTOMY & STENT FEM/POP
|
Facility
|
OP
|
$37,843.00
|
|
|
Service Code
|
CPT 37227
|
| Hospital Charge Code |
909020068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,849.58 |
| Max. Negotiated Rate |
$36,352.92 |
| Rate for Payer: Adventist Health Commercial |
$7,568.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,386.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,166.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,813.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,382.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| 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 |
$17,029.35
|
| Rate for Payer: Cash Price |
$17,029.35
|
| Rate for Payer: Cash Price |
$17,029.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24,597.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,166.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,166.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,166.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,424.82
|
| Rate for Payer: Heritage Provider Network Senior |
$23,424.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$18,051.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,849.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,460.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,490.10
|
| Rate for Payer: Multiplan Commercial |
$28,382.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,166.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,166.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,166.55
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
|
OP
|
$13,017.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,356.08 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,044.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,159.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,762.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$5,857.65
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,461.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,064.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,064.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,057.52
|
| Rate for Payer: Heritage Provider Network Senior |
$8,057.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,209.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,356.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,254.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,111.90
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,064.45
|
| Rate for Payer: Vantage Medical Group Senior |
$11,064.45
|
|
|
HC ATHRECTOMY & STENT TIBIOPER EA
|
Facility
|
IP
|
$13,017.00
|
|
|
Service Code
|
CPT 37235
|
| Hospital Charge Code |
909020076
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,356.08 |
| Max. Negotiated Rate |
$9,762.75 |
| Rate for Payer: Adventist Health Commercial |
$2,603.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,382.95
|
| Rate for Payer: Cash Price |
$5,857.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,812.51
|
| Rate for Payer: Heritage Provider Network Senior |
$8,812.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,356.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,254.25
|
| Rate for Payer: Multiplan Commercial |
$9,762.75
|
|
|
HC ATHRECTOMY & STENT TIBIOPERONE
|
Facility
|
IP
|
$22,445.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
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: Aetna of CA Non-Gatekeeper |
$14,454.58
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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 & STENT TIBIOPERONE
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
909020072
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$36,352.92 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,871.01
|
| 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 |
$9,136.00
|
| 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 |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$10,706.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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/Medicare |
$15,711.50
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| 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
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$36,352.92 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,871.01
|
| 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 |
$9,136.00
|
| 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 |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$10,706.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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/Medicare |
$15,711.50
|
| Rate for Payer: Multiplan Commercial |
$16,833.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| 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
|
Facility
|
IP
|
$22,445.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
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: Aetna of CA Non-Gatekeeper |
$14,454.58
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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 TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$22,445.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,062.55 |
| Max. Negotiated Rate |
$19,078.25 |
| Rate for Payer: Adventist Health Commercial |
$4,489.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,871.01
|
| 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 |
$5,158.00
|
| 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 |
$10,100.25
|
| Rate for Payer: Cash Price |
$10,100.25
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$10,706.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$14,454.58
|
| Rate for Payer: Cash Price |
$10,100.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,195.26
|
| Rate for Payer: Heritage Provider Network Senior |
$15,195.26
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$27,246.35
|
| Rate for Payer: Cash Price |
$19,038.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$28,642.52
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$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 Non-Gatekeeper |
$26,146.34
|
| 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 |
$8,435.00
|
| 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 |
$19,038.60
|
| Rate for Payer: Cash Price |
$19,038.60
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$20,180.92
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
$8,182.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,480.94 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,056.48
|
| 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 |
$12,185.00
|
| 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 |
$3,681.90
|
| Rate for Payer: Cash Price |
$3,681.90
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$3,902.81
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
$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: Aetna of CA Non-Gatekeeper |
$5,269.21
|
| Rate for Payer: Cash Price |
$3,681.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,539.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,539.21
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
900018230
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
900018430
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
900018130
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
900018432
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
|
