|
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: Aetna of CA Non-Gatekeeper |
$247.22
|
| Rate for Payer: Cash Price |
$172.75
|
| 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 Foundation Hospitals 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 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 Non-Gatekeeper |
$462.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| 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) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| 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 |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$482.36
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$482.36
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.07
|
| Rate for Payer: Heritage Provider Network Senior |
$507.07
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$462.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| 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) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| 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 |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
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 |
$1,257.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,292.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$3,125.70
|
| Rate for Payer: Cash Price |
$3,125.70
|
| Rate for Payer: Cash Price |
$3,125.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,514.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,299.57
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,257.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,736.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| 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 |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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: Aetna of CA Non-Gatekeeper |
$4,473.22
|
| Rate for Payer: Cash Price |
$3,125.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,702.44
|
| Rate for Payer: Heritage Provider Network Senior |
$4,702.44
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$9,518.32
|
| Rate for Payer: Cash Price |
$6,651.00
|
| Rate for Payer: Cash Price |
$6,651.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$14,780.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
906811401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,675.18 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,956.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,134.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$6,651.00
|
| Rate for Payer: Cash Price |
$6,651.00
|
| Rate for Payer: Cash Price |
$6,651.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,720.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,148.82
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,675.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,695.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| 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 |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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 |
$1,914.44 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,115.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,536.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,309.00
|
| 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 |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,240.43
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,169.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,547.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,922.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,914.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,795.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,644.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| 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 |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Aetna of CA Non-Gatekeeper |
$6,811.59
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Cash Price |
$4,759.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$1,049.72
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| 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 Foundation Hospitals 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: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,988.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,609.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$815.33
|
| Rate for Payer: Blue Shield of California Commercial |
$2,597.04
|
| 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: Blue Shield of California EPN |
$2,088.45
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$733.50
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,534.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$777.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$418.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$418.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CORONARY STENT ADD'L VESSEL
|
Facility
|
IP
|
$7,987.00
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
906811437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,445.65 |
| Max. Negotiated Rate |
$5,990.25 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,143.63
|
| Rate for Payer: Cash Price |
$3,594.15
|
| Rate for Payer: Cash Price |
$3,594.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,445.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.75
|
| Rate for Payer: Multiplan Commercial |
$5,990.25
|
|
|
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 |
$1,445.65 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,597.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,935.97
|
| 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 |
$6,245.00
|
| 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 |
$3,594.15
|
| Rate for Payer: Cash Price |
$3,594.15
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3,809.80
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
IP
|
$22,694.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,107.61 |
| Max. Negotiated Rate |
$17,020.50 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,614.94
|
| Rate for Payer: Cash Price |
$10,212.30
|
| Rate for Payer: Cash Price |
$10,212.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,107.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.50
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
|
|
HC CORONARY STENT ADD VESSEL
|
Facility
|
OP
|
$22,694.00
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
906811460
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$19,289.90 |
| Rate for Payer: Adventist Health Commercial |
$4,538.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,024.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,481.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,020.50
|
| 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 |
$10,212.30
|
| Rate for Payer: Cash Price |
$10,212.30
|
| Rate for Payer: Cash Price |
$10,212.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,751.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,289.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,289.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,389.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,047.59
|
| Rate for Payer: Heritage Provider Network Senior |
$14,047.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,825.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,107.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,673.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,885.80
|
| Rate for Payer: Multiplan Commercial |
$17,020.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,289.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,289.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,289.90
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$21,105.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,820.01 |
| Max. Negotiated Rate |
$15,828.75 |
| Rate for Payer: Adventist Health Commercial |
$4,221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,591.62
|
| Rate for Payer: Cash Price |
$9,497.25
|
| Rate for Payer: Cash Price |
$9,497.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,820.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.25
|
| Rate for Payer: Multiplan Commercial |
$15,828.75
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$21,105.00
|
|
|
Service Code
|
CPT 92928
|
| Hospital Charge Code |
906811436
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,820.01 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$4,221.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,042.89
|
| 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 |
$15,309.00
|
| 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 |
$9,497.25
|
| Rate for Payer: Cash Price |
$9,497.25
|
| Rate for Payer: Cash Price |
$9,497.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,064.00
|
| 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 |
$3,820.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$15,828.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| 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 |
$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 CORONARY STENT SINGLE VESSEL
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,786.16 |
| Max. Negotiated Rate |
$15,688.50 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,471.19
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
|
|
HC CORONARY STENT SINGLE VESSEL
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
906811459
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,927.32
|
| 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 |
$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 |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cash Price |
$9,413.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| 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 |
$12,341.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| 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 |
$3,786.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| 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 CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
OP
|
$59,267.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,627.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,645.35
|
| 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 |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,967.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,686.27
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29,633.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29,633.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC CORONARY STENT TWO OR MORE VESSELS
|
Facility
|
IP
|
$59,267.00
|
|
|
Service Code
|
CPT 92930
|
| Hospital Charge Code |
906811866
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$44,450.25 |
| Rate for Payer: Adventist Health Commercial |
$11,853.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38,167.95
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Cash Price |
$26,670.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10,727.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,816.75
|
| Rate for Payer: Multiplan Commercial |
$44,450.25
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,136.00 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,085.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,636.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,958.25
|
| 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 |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,619.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,619.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,900.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,092.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,092.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,153.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,196.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,627.70
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,619.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5,619.35
|
|
|
HC CORONARY THROMBECTOMY
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 92973
|
| Hospital Charge Code |
906812217
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,196.59 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,257.48
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Cash Price |
$2,974.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,196.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.75
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
|
