|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$36,977.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,732.75 |
| Rate for Payer: Adventist Health Commercial |
$7,395.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,403.20
|
| Rate for Payer: Cash Price |
$16,639.65
|
| Rate for Payer: Cash Price |
$16,639.65
|
| 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 |
$6,692.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,244.25
|
| Rate for Payer: Multiplan Commercial |
$27,732.75
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$31,364.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,523.00 |
| Rate for Payer: Adventist Health Commercial |
$6,272.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,547.07
|
| Rate for Payer: Cash Price |
$14,113.80
|
| Rate for Payer: Cash Price |
$14,113.80
|
| 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 |
$5,676.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,841.00
|
| Rate for Payer: Multiplan Commercial |
$23,523.00
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,094.54 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,094.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,359.90 |
| Max. Negotiated Rate |
$13,922.25 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$9,397.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,700.86 |
| Max. Negotiated Rate |
$7,047.75 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,455.74
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| 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 |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$9,397.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,094.54 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,094.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,455.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,168.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,047.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,987.45
|
| Rate for Payer: Dignity Health Senior |
$7,987.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,816.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,816.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,529.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,987.45
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$20,831.80 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,673.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,831.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,479.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,381.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,930.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,831.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,831.80
|
| Rate for Payer: Dignity Health Senior |
$20,831.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,930.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,170.45
|
| Rate for Payer: Heritage Provider Network Senior |
$15,170.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,812.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,831.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20,831.80
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$33,002.10 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,673.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,002.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,354.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,119.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,236.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,002.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,002.10
|
| Rate for Payer: Dignity Health Senior |
$33,002.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,236.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,033.29
|
| Rate for Payer: Heritage Provider Network Senior |
$24,033.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,714.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,027.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,002.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,002.10
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,435.95 |
| Max. Negotiated Rate |
$18,381.00 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| 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 |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,119.50 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| 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 |
$7,027.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.24 |
| Max. Negotiated Rate |
$19,969.90 |
| Rate for Payer: Adventist Health Commercial |
$4,698.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,472.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,140.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,921.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,969.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,969.90
|
| Rate for Payer: Dignity Health Senior |
$19,969.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,542.79
|
| Rate for Payer: Heritage Provider Network Senior |
$14,542.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,324.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,252.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,873.50
|
| Rate for Payer: Multiplan Commercial |
$17,620.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,969.90
|
| Rate for Payer: Vantage Medical Group Senior |
$19,969.90
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.24 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,472.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$23,494.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,252.41 |
| Max. Negotiated Rate |
$17,620.50 |
| Rate for Payer: Adventist Health Commercial |
$4,698.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,140.38
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Cash Price |
$10,572.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,252.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,873.50
|
| Rate for Payer: Multiplan Commercial |
$17,620.50
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,359.90 |
| Max. Negotiated Rate |
$13,922.25 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,099.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,930.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,930.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,170.45
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$26,346.75 |
| Rate for Payer: Adventist Health Commercial |
$7,025.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,776.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,133.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,833.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,833.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,744.85
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,358.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$35,129.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$26,346.75 |
| Rate for Payer: Adventist Health Commercial |
$7,025.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,133.62
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Cash Price |
$15,808.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,358.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.25
|
| Rate for Payer: Multiplan Commercial |
$26,346.75
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,435.95 |
| Max. Negotiated Rate |
$18,381.00 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| 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 |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
|
|
HC PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$123.27
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$101.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Blue Shield of California Commercial |
$152.77
|
| Rate for Payer: Blue Shield of California EPN |
$144.40
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Senior |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$212.68 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.22
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.48
|
| Rate for Payer: Heritage Provider Network Senior |
$795.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.79 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Adventist Health Commercial |
$235.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$807.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$316.27
|
| Rate for Payer: Blue Shield of California EPN |
$179.86
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cash Price |
$528.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$763.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.32
|
| Rate for Payer: Heritage Provider Network Senior |
$727.32
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$881.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$4,248.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$3,186.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
|
