|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
OP
|
$3,757.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,581.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,810.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,364.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,255.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
IP
|
$3,757.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,581.06
|
| Rate for Payer: Cash Price |
$1,690.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
IP
|
$904.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$678.00 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.05
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.01
|
| Rate for Payer: Heritage Provider Network Senior |
$612.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.00
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
OP
|
$904.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$587.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.01
|
| Rate for Payer: Heritage Provider Network Senior |
$612.01
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$328.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
OP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,765.50 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,055.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,496.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,931.35
|
| 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 |
$9,167.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,457.70
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: 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 |
$2,765.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.75
|
| 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 |
$11,459.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 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 INTRAVASC LITHOTRIPSY
|
Facility
IP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,765.50 |
| Max. Negotiated Rate |
$11,459.25 |
| Rate for Payer: Adventist Health Commercial |
$3,055.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,496.67
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,343.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10,343.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,765.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.75
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
OP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,765.50 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,055.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,496.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,931.35
|
| 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 |
$9,167.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,457.70
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: 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 |
$2,765.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.75
|
| 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 |
$11,459.25
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 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 INTRAVASC LITHOTRIPSY
|
Facility
IP
|
$15,279.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,765.50 |
| Max. Negotiated Rate |
$11,459.25 |
| Rate for Payer: Adventist Health Commercial |
$3,055.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,496.67
|
| Rate for Payer: Cash Price |
$6,875.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,343.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10,343.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,765.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.75
|
| Rate for Payer: Multiplan Commercial |
$11,459.25
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,531.54 |
| Max. Negotiated Rate |
$22,920.75 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,689.80
|
| Rate for Payer: Heritage Provider Network Senior |
$20,689.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906820314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,864.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,336.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,917.26
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,531.54 |
| Max. Negotiated Rate |
$22,920.75 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,689.80
|
| Rate for Payer: Heritage Provider Network Senior |
$20,689.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
|
|
HC INTRAVASC LITHOTRIPSY ATHRCTMY
|
Facility
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9766
|
| Hospital Charge Code |
906819766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,088.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,864.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,336.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,917.26
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,531.54 |
| Max. Negotiated Rate |
$22,920.75 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,689.80
|
| Rate for Payer: Heritage Provider Network Senior |
$20,689.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906819765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,857.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,864.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,336.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,917.26
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
IP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,531.54 |
| Max. Negotiated Rate |
$22,920.75 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,689.80
|
| Rate for Payer: Heritage Provider Network Senior |
$20,689.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
|
|
HC INTRAVASC LITHOTRIPSY STENT
|
Facility
OP
|
$30,561.00
|
|
|
Service Code
|
CPT C9765
|
| Hospital Charge Code |
906820313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,857.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$6,112.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,995.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cash Price |
$13,752.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,864.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,336.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,917.26
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,531.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,640.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$22,920.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
OP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$648.00
|
| 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 |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$561.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Senior |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.82
|
| Rate for Payer: Heritage Provider Network Senior |
$534.82
|
| Rate for Payer: IEHP Medi-Cal |
$304.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$416.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| 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 |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
IP
|
$864.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
906820020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.57
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.93
|
| Rate for Payer: Heritage Provider Network Senior |
$584.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
OP
|
$698.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$523.50
|
| 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 |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Senior |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.06
|
| Rate for Payer: Heritage Provider Network Senior |
$432.06
|
| Rate for Payer: IEHP Medi-Cal |
$304.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| 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 |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
IP
|
$698.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$523.50 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.55
|
| Rate for Payer: Heritage Provider Network Senior |
$472.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
OP
|
$698.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$523.50
|
| 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 |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Senior |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$432.06
|
| Rate for Payer: Heritage Provider Network Senior |
$432.06
|
| Rate for Payer: IEHP Medi-Cal |
$2,029.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| 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 |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
IP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.57
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.93
|
| Rate for Payer: Heritage Provider Network Senior |
$584.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
IP
|
$698.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$523.50 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.53
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.55
|
| Rate for Payer: Heritage Provider Network Senior |
$472.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.50
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
OP
|
$864.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
906820019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$593.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$734.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$475.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$648.00
|
| 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 |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$561.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$734.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$734.40
|
| Rate for Payer: Dignity Health Senior |
$734.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.82
|
| Rate for Payer: Heritage Provider Network Senior |
$534.82
|
| Rate for Payer: IEHP Medi-Cal |
$2,029.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$416.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| 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 |
$734.40
|
| Rate for Payer: Vantage Medical Group Senior |
$734.40
|
|
|
HC INTRCRNL INF NON THROM EA ADD
|
Facility
IP
|
$2,685.00
|
|
|
Service Code
|
CPT 61651
|
| Hospital Charge Code |
909061651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.98 |
| Max. Negotiated Rate |
$2,013.75 |
| Rate for Payer: Adventist Health Commercial |
$537.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,844.60
|
| Rate for Payer: Cash Price |
$1,208.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,817.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,817.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.25
|
| Rate for Payer: Multiplan Commercial |
$2,013.75
|
|
