|
HC INTRA-ART INJ OR INFUS
|
Facility
OP
|
$895.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$671.25 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$581.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$581.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$554.00
|
| Rate for Payer: Heritage Provider Network Senior |
$554.00
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: IEHP Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
IP
|
$36,376.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,584.06 |
| Max. Negotiated Rate |
$27,282.00 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,626.55
|
| Rate for Payer: Heritage Provider Network Senior |
$24,626.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
OP
|
$36,376.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.24 |
| Max. Negotiated Rate |
$30,919.60 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30,919.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,006.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,282.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,644.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,919.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,919.60
|
| Rate for Payer: Dignity Health Senior |
$30,919.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,516.74
|
| Rate for Payer: Heritage Provider Network Senior |
$22,516.74
|
| Rate for Payer: IEHP Medi-Cal |
$1,389.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,533.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,919.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30,919.60
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
IP
|
$38,623.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,990.76 |
| Max. Negotiated Rate |
$28,967.25 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,147.77
|
| Rate for Payer: Heritage Provider Network Senior |
$26,147.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
OP
|
$38,623.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906820318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.24 |
| Max. Negotiated Rate |
$32,829.55 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,242.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28,967.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,104.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,829.55
|
| Rate for Payer: Dignity Health Senior |
$32,829.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,907.64
|
| Rate for Payer: Heritage Provider Network Senior |
$23,907.64
|
| Rate for Payer: IEHP Medi-Cal |
$1,389.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,616.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,829.55
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
IP
|
$38,623.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,990.76 |
| Max. Negotiated Rate |
$28,967.25 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,147.77
|
| Rate for Payer: Heritage Provider Network Senior |
$26,147.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
OP
|
$36,376.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$30,919.60 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30,919.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,006.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,282.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,644.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30,919.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30,919.60
|
| Rate for Payer: Dignity Health Senior |
$30,919.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,516.74
|
| Rate for Payer: Heritage Provider Network Senior |
$22,516.74
|
| Rate for Payer: IEHP Medi-Cal |
$110.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,533.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30,919.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30,919.60
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
OP
|
$38,623.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906820319
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$32,829.55 |
| Rate for Payer: Adventist Health Commercial |
$7,724.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,534.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,829.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,242.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28,967.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cash Price |
$17,380.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,104.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,829.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,829.55
|
| Rate for Payer: Dignity Health Senior |
$32,829.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,907.64
|
| Rate for Payer: Heritage Provider Network Senior |
$23,907.64
|
| Rate for Payer: IEHP Medi-Cal |
$110.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,616.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,990.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,655.75
|
| Rate for Payer: Multiplan Commercial |
$28,967.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,829.55
|
| Rate for Payer: Vantage Medical Group Senior |
$32,829.55
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
IP
|
$36,376.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,584.06 |
| Max. Negotiated Rate |
$27,282.00 |
| Rate for Payer: Adventist Health Commercial |
$7,275.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,990.31
|
| Rate for Payer: Cash Price |
$16,369.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,626.55
|
| Rate for Payer: Heritage Provider Network Senior |
$24,626.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,584.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,094.00
|
| Rate for Payer: Multiplan Commercial |
$27,282.00
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
IP
|
$8,679.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,570.90 |
| Max. Negotiated Rate |
$6,509.25 |
| Rate for Payer: Adventist Health Commercial |
$1,735.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,962.47
|
| Rate for Payer: Cash Price |
$3,905.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,875.68
|
| Rate for Payer: Heritage Provider Network Senior |
$5,875.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,570.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,169.75
|
| Rate for Payer: Multiplan Commercial |
$6,509.25
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
IP
|
$1,280.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.68 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Adventist Health Commercial |
$256.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$879.36
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$866.56
|
| Rate for Payer: Heritage Provider Network Senior |
$866.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
OP
|
$8,679.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,735.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,962.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,377.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,773.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,509.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$3,905.55
|
| Rate for Payer: Cash Price |
$3,905.55
|
| Rate for Payer: Cash Price |
$3,905.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,641.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,377.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,377.15
|
| Rate for Payer: Dignity Health Senior |
$7,377.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,372.30
|
| Rate for Payer: Heritage Provider Network Senior |
$5,372.30
|
| Rate for Payer: IEHP Medi-Cal |
$282.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,183.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,570.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,169.75
|
| Rate for Payer: Multiplan Commercial |
$6,509.25
|
| 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 |
$7,377.15
|
| Rate for Payer: Vantage Medical Group Senior |
$7,377.15
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
OP
|
$1,280.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$256.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$879.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,088.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$704.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$960.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$832.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,088.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,088.00
|
| Rate for Payer: Dignity Health Senior |
$1,088.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.32
|
| Rate for Payer: Heritage Provider Network Senior |
$792.32
|
| Rate for Payer: IEHP Medi-Cal |
$282.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$616.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| 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 |
$1,088.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,088.00
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
OP
|
$16,905.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,033.22 |
| Max. Negotiated Rate |
$14,369.25 |
| Rate for Payer: Adventist Health Commercial |
$3,381.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,613.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14,369.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,297.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$7,607.25
|
| Rate for Payer: Cash Price |
$7,607.25
|
| Rate for Payer: Cash Price |
$7,607.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,988.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,369.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,369.25
|
| Rate for Payer: Dignity Health Senior |
$14,369.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,143.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,464.20
|
| Rate for Payer: Heritage Provider Network Senior |
$10,464.20
|
| Rate for Payer: IEHP Medi-Cal |
$1,033.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,148.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,059.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,226.25
|
| Rate for Payer: Multiplan Commercial |
$12,678.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,369.25
|
| Rate for Payer: Vantage Medical Group Senior |
$14,369.25
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
IP
|
$16,905.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,059.80 |
| Max. Negotiated Rate |
$12,678.75 |
| Rate for Payer: Adventist Health Commercial |
$3,381.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,613.74
|
| Rate for Payer: Cash Price |
$7,607.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,444.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11,444.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,059.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,226.25
|
| Rate for Payer: Multiplan Commercial |
$12,678.75
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
OP
|
$5,370.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$692.87 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,074.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,689.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,564.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,953.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,027.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$2,416.50
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,490.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,564.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,564.50
|
| Rate for Payer: Dignity Health Senior |
$4,564.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,222.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,324.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,324.03
|
| Rate for Payer: IEHP Medi-Cal |
$692.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,588.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.50
|
| Rate for Payer: Multiplan Commercial |
$4,027.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,564.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,564.50
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
IP
|
$5,370.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$971.97 |
| Max. Negotiated Rate |
$4,027.50 |
| Rate for Payer: Adventist Health Commercial |
$1,074.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,689.19
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,635.49
|
| Rate for Payer: Heritage Provider Network Senior |
$3,635.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.50
|
| Rate for Payer: Multiplan Commercial |
$4,027.50
|
|
|
HC INTRANASAL BX
|
Facility
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.87 |
| Max. Negotiated Rate |
$2,365.50 |
| Rate for Payer: Adventist Health Commercial |
$630.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,166.80
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,135.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,135.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.50
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
|
|
HC INTRANASAL BX
|
Facility
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$630.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,166.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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 |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,050.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,952.33
|
| Rate for Payer: Heritage Provider Network Senior |
$2,343.69
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$56.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,620.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$788.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,095.98
|
| Rate for Payer: TriValley Medical Group Senior |
$2,095.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$332.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$933.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$603.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$823.50
|
| 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 |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$713.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$933.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$933.30
|
| Rate for Payer: Dignity Health Senior |
$933.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$713.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.66
|
| Rate for Payer: Heritage Provider Network Senior |
$679.66
|
| Rate for Payer: IEHP Medi-Cal |
$876.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$529.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| 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 |
$933.30
|
| Rate for Payer: Vantage Medical Group Senior |
$933.30
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$754.33
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.50
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
OP
|
$4,873.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$882.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,347.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,167.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,299.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3,299.02
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,348.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$3,654.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,769.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
IP
|
$4,873.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$882.01 |
| Max. Negotiated Rate |
$3,654.75 |
| Rate for Payer: Adventist Health Commercial |
$974.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,347.75
|
| Rate for Payer: Cash Price |
$2,192.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,299.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3,299.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.25
|
| Rate for Payer: Multiplan Commercial |
$3,654.75
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
OP
|
$5,255.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,051.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,364.75
|
| Rate for Payer: Cash Price |
$2,364.75
|
| Rate for Payer: Cash Price |
$2,364.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,415.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,557.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,557.64
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,532.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$3,941.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,908.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,755.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
IP
|
$5,255.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$951.16 |
| Max. Negotiated Rate |
$3,941.25 |
| Rate for Payer: Adventist Health Commercial |
$1,051.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.18
|
| Rate for Payer: Cash Price |
$2,364.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,557.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,557.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,313.75
|
| Rate for Payer: Multiplan Commercial |
$3,941.25
|
|
