|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
|
IP
|
$675.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$506.44 |
| Rate for Payer: Adventist Health Commercial |
$135.05
|
| Rate for Payer: Cash Price |
$371.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.64
|
| Rate for Payer: Heritage Provider Network Senior |
$312.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.81
|
| Rate for Payer: Multiplan Commercial |
$506.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.58
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
|
OP
|
$675.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$573.96 |
| Rate for Payer: Adventist Health Commercial |
$135.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$360.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$573.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$506.44
|
| Rate for Payer: Blue Shield of California Commercial |
$411.90
|
| Rate for Payer: Blue Shield of California EPN |
$329.52
|
| Rate for Payer: Cash Price |
$371.39
|
| Rate for Payer: Cash Price |
$371.39
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.96
|
| Rate for Payer: Dignity Health Senior |
$573.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.64
|
| Rate for Payer: Heritage Provider Network Senior |
$312.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$322.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.68
|
| Rate for Payer: Multiplan Commercial |
$506.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$270.10
|
| Rate for Payer: TriValley Medical Group Senior |
$270.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$573.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.96
|
| Rate for Payer: Vantage Medical Group Senior |
$573.96
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
OP
|
$491.28
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$417.59 |
| Rate for Payer: Adventist Health Commercial |
$98.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$262.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$337.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$417.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$270.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$368.46
|
| Rate for Payer: Blue Shield of California Commercial |
$299.68
|
| Rate for Payer: Blue Shield of California EPN |
$239.74
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$225.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$417.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.59
|
| Rate for Payer: Dignity Health Senior |
$417.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.46
|
| Rate for Payer: Heritage Provider Network Senior |
$227.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.90
|
| Rate for Payer: Multiplan Commercial |
$368.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.51
|
| Rate for Payer: TriValley Medical Group Senior |
$196.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$417.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.59
|
| Rate for Payer: Vantage Medical Group Senior |
$417.59
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
IP
|
$491.28
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$368.46 |
| Rate for Payer: Adventist Health Commercial |
$98.26
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$225.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.46
|
| Rate for Payer: Heritage Provider Network Senior |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$368.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.66
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
IP
|
$383.88
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$287.91 |
| Rate for Payer: Adventist Health Commercial |
$76.78
|
| Rate for Payer: Cash Price |
$211.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.74
|
| Rate for Payer: Heritage Provider Network Senior |
$177.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.97
|
| Rate for Payer: Multiplan Commercial |
$287.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$127.10
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
OP
|
$383.88
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Adventist Health Commercial |
$76.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.91
|
| Rate for Payer: Blue Shield of California Commercial |
$234.17
|
| Rate for Payer: Blue Shield of California EPN |
$187.33
|
| Rate for Payer: Cash Price |
$211.13
|
| Rate for Payer: Cash Price |
$211.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$326.30
|
| Rate for Payer: Dignity Health Senior |
$326.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.74
|
| Rate for Payer: Heritage Provider Network Senior |
$177.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$183.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.72
|
| Rate for Payer: Multiplan Commercial |
$287.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$153.55
|
| Rate for Payer: TriValley Medical Group Senior |
$153.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$127.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$326.30
|
| Rate for Payer: Vantage Medical Group Senior |
$326.30
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$400.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$456.89
|
| Rate for Payer: Blue Shield of California EPN |
$365.51
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$374.50
|
| Rate for Payer: TriValley Medical Group Senior |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$561.75 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$400.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$514.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$456.89
|
| Rate for Payer: Blue Shield of California EPN |
$365.51
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.63
|
| Rate for Payer: Heritage Provider Network Senior |
$463.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$357.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$374.50
|
| Rate for Payer: TriValley Medical Group Senior |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,257.23 |
| Max. Negotiated Rate |
$5,209.50 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,702.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,702.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,257.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.50
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,771.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$3,820.30
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Cash Price |
$3,820.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,514.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,299.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,423.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,257.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$16,451.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,275.99 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,290.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,301.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$9,048.05
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,693.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,183.17
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,275.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,977.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$12,338.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$14,780.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,675.18 |
| Max. Negotiated Rate |
$11,085.00 |
| Rate for Payer: Adventist Health Commercial |
$2,956.00
|
| Rate for Payer: Cash Price |
$8,129.00
|
| Rate for Payer: Cash Price |
$8,129.00
|
| 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 |
$2,675.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,695.00
|
| Rate for Payer: Multiplan Commercial |
$11,085.00
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
IP
|
$16,451.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906820059
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,977.63 |
| Max. Negotiated Rate |
$12,338.25 |
| Rate for Payer: Adventist Health Commercial |
$3,290.20
|
| Rate for Payer: Cash Price |
$9,048.05
|
| Rate for Payer: Cash Price |
$9,048.05
|
| 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 |
$2,977.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,112.75
|
| Rate for Payer: Multiplan Commercial |
$12,338.25
|
|
|
HC CORO CATH, CORO ANGIO
|
Facility
|
OP
|
$14,780.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,275.99 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,956.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,153.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$8,129.00
|
| Rate for Payer: Cash Price |
$8,129.00
|
| Rate for Payer: Cash Price |
$8,129.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,607.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,148.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,275.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,675.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,695.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$11,085.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$14,079.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,489.57 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,815.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,672.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$7,743.45
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,151.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,714.90
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,489.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,519.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$10,559.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$10,577.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,914.44 |
| Max. Negotiated Rate |
$7,932.75 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| 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 |
$1,914.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
OP
|
$10,577.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906811402
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,489.57 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,266.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cash Price |
$5,817.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Senior |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,875.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,086.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,547.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,026.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,489.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,764.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,149.33
|
| Rate for Payer: Multiplan Commercial |
$7,932.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC CORO CATH, CORO ANGIO,GRAFT,IM
|
Facility
|
IP
|
$14,079.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
906820060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,548.30 |
| Max. Negotiated Rate |
$10,559.25 |
| Rate for Payer: Adventist Health Commercial |
$2,815.80
|
| Rate for Payer: Cash Price |
$7,743.45
|
| Rate for Payer: Cash Price |
$7,743.45
|
| 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 |
$2,548.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,519.75
|
| Rate for Payer: Multiplan Commercial |
$10,559.25
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$295.03 |
| Max. Negotiated Rate |
$1,222.50 |
| Rate for Payer: Adventist Health Commercial |
$326.00
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,103.51
|
| Rate for Payer: Heritage Provider Network Senior |
$1,103.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.50
|
| Rate for Payer: Multiplan Commercial |
$1,222.50
|
|
|
HC CORONARY CTA W/MORPH W/O CCS
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
909201402
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,597.04 |
| Rate for Payer: Adventist Health Commercial |
$326.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,119.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,597.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.45
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: Cash Price |
$896.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$505.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$777.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,222.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$418.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$9,397.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906820240
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,455.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,168.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,047.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$5,168.35
|
| Rate for Payer: Cash Price |
$5,168.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,987.45
|
| Rate for Payer: Dignity Health Senior |
$7,987.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,816.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,816.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,482.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,577.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,577.90
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
| 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 |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,987.45
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$9,397.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906820240
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,700.86 |
| Max. Negotiated Rate |
$7,047.75 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Cash Price |
$5,168.35
|
| Rate for Payer: Cash Price |
$5,168.35
|
| 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 |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
OP
|
$7,987.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,487.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,788.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,392.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,990.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cash Price |
$4,392.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,788.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,788.95
|
| Rate for Payer: Dignity Health Senior |
$6,788.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,943.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,943.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,809.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,590.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,590.90
|
| Rate for Payer: Multiplan Commercial |
$5,990.25
|
| 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 |
$6,788.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,788.95
|
| Rate for Payer: Vantage Medical Group Senior |
$6,788.95
|
|
