|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,491.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| 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 |
$1,994.85
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Cash Price |
$1,994.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,357.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,245.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,576.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,070.32
|
| Rate for Payer: TriValley Medical Group Senior |
$2,070.32
|
| 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 |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$188.78 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$208.60
|
| Rate for Payer: Cash Price |
$573.65
|
| Rate for Payer: Cash Price |
$573.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.75
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$188.78 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$208.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$557.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$716.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$886.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$573.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$782.25
|
| 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 |
$573.65
|
| Rate for Payer: Cash Price |
$573.65
|
| Rate for Payer: Cash Price |
$573.65
|
| Rate for Payer: Cash Price |
$573.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$886.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$886.55
|
| Rate for Payer: Dignity Health Senior |
$886.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.62
|
| Rate for Payer: Heritage Provider Network Senior |
$645.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$909.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$497.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$730.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$730.10
|
| Rate for Payer: Multiplan Commercial |
$782.25
|
| 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 |
$886.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$886.55
|
| Rate for Payer: Vantage Medical Group Senior |
$886.55
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$5,323.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,656.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,927.65
|
| Rate for Payer: Cash Price |
$2,927.65
|
| Rate for Payer: Cash Price |
$2,927.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,459.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Senior |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,120.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,603.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,603.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,539.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,738.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,192.01
|
| Rate for Payer: Multiplan Commercial |
$3,992.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,915.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,762.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$5,323.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.46 |
| Max. Negotiated Rate |
$3,992.25 |
| Rate for Payer: Adventist Health Commercial |
$1,064.60
|
| Rate for Payer: Cash Price |
$2,927.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,603.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,603.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.75
|
| Rate for Payer: Multiplan Commercial |
$3,992.25
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$5,741.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,039.12 |
| Max. Negotiated Rate |
$4,305.75 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Cash Price |
$3,157.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,886.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,886.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$5,741.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,944.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$3,157.55
|
| Rate for Payer: Cash Price |
$3,157.55
|
| Rate for Payer: Cash Price |
$3,157.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,731.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,886.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,886.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,738.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,039.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,065.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,900.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Adventist Health Commercial |
$820.80
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.00
|
| Rate for Payer: Multiplan Commercial |
$3,078.00
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$820.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,819.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cash Price |
$2,257.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,667.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,957.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$3,078.00
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,476.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,358.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$642.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$471.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$355.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$327.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$13,040.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,360.24 |
| Max. Negotiated Rate |
$9,780.00 |
| Rate for Payer: Adventist Health Commercial |
$2,608.00
|
| Rate for Payer: Cash Price |
$7,172.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,828.08
|
| Rate for Payer: Heritage Provider Network Senior |
$8,828.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,360.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,260.00
|
| Rate for Payer: Multiplan Commercial |
$9,780.00
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$13,040.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,608.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,958.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| 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 |
$7,172.00
|
| Rate for Payer: Cash Price |
$7,172.00
|
| Rate for Payer: Cash Price |
$7,172.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,476.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,824.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,071.76
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,360.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,260.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$9,780.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,627.22 |
| Max. Negotiated Rate |
$10,886.25 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Cash Price |
$7,983.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,826.66
|
| Rate for Payer: Heritage Provider Network Senior |
$9,826.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,627.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,628.75
|
| Rate for Payer: Multiplan Commercial |
$10,886.25
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,971.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| 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 |
$7,983.25
|
| Rate for Payer: Cash Price |
$7,983.25
|
| Rate for Payer: Cash Price |
$7,983.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,434.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,709.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,984.78
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,627.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,628.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$10,886.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$26,083.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,919.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$14,345.65
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,953.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,649.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,145.38
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,721.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$29,033.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.97 |
| Max. Negotiated Rate |
$21,774.75 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$19,655.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,254.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,258.25
|
| Rate for Payer: Multiplan Commercial |
$21,774.75
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
OP
|
$29,033.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,945.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$15,968.15
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,871.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,419.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,971.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,254.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,258.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$21,774.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
|
IP
|
$26,083.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$19,562.25 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,658.19
|
| Rate for Payer: Heritage Provider Network Senior |
$17,658.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,721.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$29,033.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.97 |
| Max. Negotiated Rate |
$21,774.75 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,655.34
|
| Rate for Payer: Heritage Provider Network Senior |
$19,655.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,254.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,258.25
|
| Rate for Payer: Multiplan Commercial |
$21,774.75
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$29,033.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,806.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,945.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$15,968.15
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Cash Price |
$15,968.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,871.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,419.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,971.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,254.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,258.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$21,774.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
OP
|
$26,083.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,919.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$14,345.65
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,953.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,649.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,145.38
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,721.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
|
IP
|
$26,083.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,721.02 |
| Max. Negotiated Rate |
$19,562.25 |
| Rate for Payer: Adventist Health Commercial |
$5,216.60
|
| Rate for Payer: Cash Price |
$14,345.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,658.19
|
| Rate for Payer: Heritage Provider Network Senior |
$17,658.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,721.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,520.75
|
| Rate for Payer: Multiplan Commercial |
$19,562.25
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
OP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,913.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,029.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,026.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,490.75
|
| 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 |
$4,026.55
|
| Rate for Payer: Cash Price |
$4,026.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,222.85
|
| Rate for Payer: Dignity Health Senior |
$6,222.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,758.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,531.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,531.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,492.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,325.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,124.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,124.70
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,660.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,660.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,222.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,222.85
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
IP
|
$7,321.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,325.10 |
| Max. Negotiated Rate |
$5,490.75 |
| Rate for Payer: Adventist Health Commercial |
$1,464.20
|
| Rate for Payer: Cash Price |
$4,026.55
|
| Rate for Payer: Cash Price |
$4,026.55
|
| 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 |
$1,325.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,830.25
|
| Rate for Payer: Multiplan Commercial |
$5,490.75
|
|
