|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.42 |
| Max. Negotiated Rate |
$1,696.50 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,531.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,531.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
|
|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.76 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,470.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$246.76
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
OP
|
$2,545.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$509.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,748.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,145.25
|
| Rate for Payer: Cash Price |
$1,145.25
|
| Rate for Payer: Cash Price |
$1,145.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,654.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,575.36
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$22.07
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,908.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.48 |
| Max. Negotiated Rate |
$1,812.75 |
| Rate for Payer: Adventist Health Commercial |
$483.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,660.48
|
| Rate for Payer: Cash Price |
$1,087.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,636.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,636.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.25
|
| Rate for Payer: Multiplan Commercial |
$1,812.75
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
IP
|
$2,545.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$460.64 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Adventist Health Commercial |
$509.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,748.42
|
| Rate for Payer: Cash Price |
$1,145.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,722.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,722.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$460.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.25
|
| Rate for Payer: Multiplan Commercial |
$1,908.75
|
|
|
HC INJ CHEST TUBE W/FIBRINOLYTIC
|
Facility
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$483.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,660.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,087.65
|
| Rate for Payer: Cash Price |
$1,087.65
|
| Rate for Payer: Cash Price |
$1,087.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,571.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,496.12
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$124.29
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$1,812.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.43
|
| Rate for Payer: Heritage Provider Network Senior |
$399.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.43
|
| Rate for Payer: Heritage Provider Network Senior |
$399.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$501.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$501.50
|
| Rate for Payer: Dignity Health Senior |
$501.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.43
|
| Rate for Payer: Heritage Provider Network Senior |
$399.43
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$284.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$214.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$197.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$501.50
|
| Rate for Payer: Vantage Medical Group Senior |
$501.50
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$501.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$442.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$501.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$501.50
|
| Rate for Payer: Dignity Health Senior |
$501.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.21
|
| Rate for Payer: Heritage Provider Network Senior |
$365.21
|
| Rate for Payer: IEHP Medi-Cal |
$203.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$284.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$501.50
|
| Rate for Payer: Vantage Medical Group Senior |
$501.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| 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 |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$213.29 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,087.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,289.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| 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 |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| 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 |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$144.48 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,087.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,289.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| 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 |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,087.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,289.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| 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 |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| 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 |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
IP
|
$4,750.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| 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 |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
OP
|
$4,750.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$950.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$159.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,263.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,037.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,612.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,562.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cash Price |
$2,137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,087.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,037.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,037.50
|
| Rate for Payer: Dignity Health Senior |
$4,037.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,087.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,940.25
|
| Rate for Payer: Heritage Provider Network Senior |
$2,940.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,289.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$859.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,187.50
|
| Rate for Payer: Multiplan Commercial |
$3,562.50
|
| 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 |
$4,037.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,037.50
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.39 |
| Max. Negotiated Rate |
$1,974.00 |
| Rate for Payer: Adventist Health Commercial |
$526.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,808.18
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,781.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,781.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.00
|
| Rate for Payer: Multiplan Commercial |
$1,974.00
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$526.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,808.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,710.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,579.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,629.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$304.92
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,974.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
OP
|
$3,310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.63 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$662.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,273.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,151.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,048.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$198.63
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$599.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
IP
|
$3,310.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$599.11 |
| Max. Negotiated Rate |
$2,482.50 |
| Rate for Payer: Adventist Health Commercial |
$662.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,273.97
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,240.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,240.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$599.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$827.50
|
| Rate for Payer: Multiplan Commercial |
$2,482.50
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
IP
|
$2,480.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.88 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Adventist Health Commercial |
$496.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,703.76
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,678.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,678.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$620.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
OP
|
$1,382.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$276.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$949.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cash Price |
$621.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$898.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$855.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$218.96
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,036.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
IP
|
$6,065.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,097.76 |
| Max. Negotiated Rate |
$4,548.75 |
| Rate for Payer: Adventist Health Commercial |
$1,213.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,166.66
|
| Rate for Payer: Cash Price |
$2,729.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,106.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,106.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.25
|
| Rate for Payer: Multiplan Commercial |
$4,548.75
|
|
