|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,917.51 |
| Max. Negotiated Rate |
$7,945.50 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,172.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,172.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,917.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
|
|
HC INTESTINE CELLVIZIO
|
Facility
|
IP
|
$10,594.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906744799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,917.51 |
| Max. Negotiated Rate |
$7,945.50 |
| Rate for Payer: Adventist Health Commercial |
$2,118.80
|
| Rate for Payer: Cash Price |
$5,826.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,172.14
|
| Rate for Payer: Heritage Provider Network Senior |
$7,172.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,917.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,648.50
|
| Rate for Payer: Multiplan Commercial |
$7,945.50
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$18,953.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,063.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,652.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,253.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$1,652.20
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,553.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,553.40
|
| Rate for Payer: Dignity Health Senior |
$2,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,859.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,859.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$351.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,432.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.80
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
| 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 |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,553.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,553.40
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
OP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$18,953.00 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,753.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,404.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,914.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$1,404.15
|
| Rate for Payer: Cash Price |
$1,404.15
|
| Rate for Payer: Cash Price |
$1,404.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,659.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,170.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,170.05
|
| Rate for Payer: Dignity Health Senior |
$2,170.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,580.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,580.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$351.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,787.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,787.10
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
| 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 |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,170.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,170.05
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$3,004.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906820104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.72 |
| Max. Negotiated Rate |
$2,253.00 |
| Rate for Payer: Adventist Health Commercial |
$600.80
|
| Rate for Payer: Cash Price |
$1,652.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,033.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,033.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.00
|
| Rate for Payer: Multiplan Commercial |
$2,253.00
|
|
|
HC INTRA AORTIC BALLOON INSERTION
|
Facility
|
IP
|
$2,553.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
906811310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.09 |
| Max. Negotiated Rate |
$1,914.75 |
| Rate for Payer: Adventist Health Commercial |
$510.60
|
| Rate for Payer: Cash Price |
$1,404.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,728.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,728.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$1,914.75
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$448.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$545.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Senior |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$545.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.34
|
| Rate for Payer: Heritage Provider Network Senior |
$519.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.87
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.49
|
| Rate for Payer: TriValley Medical Group Senior |
$58.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC INTRA-ART INJ OR INFUS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$629.25 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Cash Price |
$461.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,641.25 |
| Max. Negotiated Rate |
$27,519.00 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,840.48
|
| Rate for Payer: Heritage Provider Network Senior |
$24,840.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,173.00
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$31,046.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,619.33 |
| Max. Negotiated Rate |
$23,284.50 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,018.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21,018.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$31,046.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.30 |
| Max. Negotiated Rate |
$26,389.10 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,328.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,075.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,284.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$17,075.30
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,389.10
|
| Rate for Payer: Dignity Health Senior |
$26,389.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,217.47
|
| Rate for Payer: Heritage Provider Network Senior |
$19,217.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,808.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,732.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,732.20
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
| 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 |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Senior |
$26,389.10
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.30 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,207.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,180.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,519.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,849.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,188.20
|
| Rate for Payer: Dignity Health Senior |
$31,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,712.35
|
| Rate for Payer: Heritage Provider Network Senior |
$22,712.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,684.40
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
| 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 |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31,188.20
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$31,046.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,619.33 |
| Max. Negotiated Rate |
$23,284.50 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,018.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21,018.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,641.25 |
| Max. Negotiated Rate |
$27,519.00 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,840.48
|
| Rate for Payer: Heritage Provider Network Senior |
$24,840.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,173.00
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$31,046.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.76 |
| Max. Negotiated Rate |
$26,389.10 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,328.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,075.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,284.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$17,075.30
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Cash Price |
$17,075.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,389.10
|
| Rate for Payer: Dignity Health Senior |
$26,389.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,217.47
|
| Rate for Payer: Heritage Provider Network Senior |
$19,217.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$571.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,808.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,732.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,732.20
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
| 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 |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Senior |
$26,389.10
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$36,692.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.76 |
| Max. Negotiated Rate |
$31,188.20 |
| Rate for Payer: Adventist Health Commercial |
$7,338.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,207.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,180.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,519.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cash Price |
$20,180.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,849.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,188.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,188.20
|
| Rate for Payer: Dignity Health Senior |
$31,188.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,712.35
|
| Rate for Payer: Heritage Provider Network Senior |
$22,712.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$571.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,502.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,641.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25,684.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,684.40
|
| Rate for Payer: Multiplan Commercial |
$27,519.00
|
| 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 |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,188.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31,188.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$859.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| 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 |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$813.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Senior |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$774.37
|
| Rate for Payer: Heritage Provider Network Senior |
$774.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$596.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| 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 |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.10 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$823.23
|
| Rate for Payer: Heritage Provider Network Senior |
$823.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.43 |
| Max. Negotiated Rate |
$938.25 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.93
|
| Rate for Payer: Heritage Provider Network Senior |
$846.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$835.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.00
|
| 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 |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$790.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.60
|
| Rate for Payer: Dignity Health Senior |
$1,033.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$752.70
|
| Rate for Payer: Heritage Provider Network Senior |
$752.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$580.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$851.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$851.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| 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 |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.60
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,046.62 |
| Max. Negotiated Rate |
$16,767.75 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Cash Price |
$12,296.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,135.69
|
| Rate for Payer: Heritage Provider Network Senior |
$15,135.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,046.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.25
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,003.45 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,359.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,296.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,767.75
|
| 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 |
$12,296.35
|
| Rate for Payer: Cash Price |
$12,296.35
|
| Rate for Payer: Cash Price |
$12,296.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,532.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,003.45
|
| Rate for Payer: Dignity Health Senior |
$19,003.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,414.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,838.98
|
| Rate for Payer: Heritage Provider Network Senior |
$13,838.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,072.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,664.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,046.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,649.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,649.90
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
| 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 |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,003.45
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,879.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,906.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,326.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$3,906.10
|
| Rate for Payer: Cash Price |
$3,906.10
|
| Rate for Payer: Cash Price |
$3,906.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,616.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,036.70
|
| Rate for Payer: Dignity Health Senior |
$6,036.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,261.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,396.14
|
| Rate for Payer: Heritage Provider Network Senior |
$4,396.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,387.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,775.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,971.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,971.40
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
| 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 |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6,036.70
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,285.46 |
| Max. Negotiated Rate |
$5,326.50 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Cash Price |
$3,906.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,808.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,808.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,285.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,775.50
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
|
|
HC INTRANASAL BX
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$2,720.25 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,455.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
|
