|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$2,873.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,870.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,339.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,893.79
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
| 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 PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,630.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,648.03 |
| Max. Negotiated Rate |
$10,972.50 |
| Rate for Payer: Adventist Health Commercial |
$2,926.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,050.81
|
| Rate for Payer: Cash Price |
$6,583.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,904.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9,904.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,648.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,657.50
|
| Rate for Payer: Multiplan Commercial |
$10,972.50
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,600.61 |
| Max. Negotiated Rate |
$10,776.00 |
| Rate for Payer: Adventist Health Commercial |
$2,873.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,870.82
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,727.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9,727.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.00
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$14,033.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,928.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,718.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,524.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,121.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,928.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,928.05
|
| Rate for Payer: Dignity Health Senior |
$11,928.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,686.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,686.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,763.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,928.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,928.05
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,090.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,478.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: Dignity Health Senior |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,978.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9,978.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,769.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,917.72 |
| Max. Negotiated Rate |
$12,090.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,913.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,913.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$14,033.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,539.97 |
| Max. Negotiated Rate |
$10,524.75 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,500.34
|
| Rate for Payer: Heritage Provider Network Senior |
$9,500.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$12,222.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,212.18 |
| Max. Negotiated Rate |
$9,166.50 |
| Rate for Payer: Adventist Health Commercial |
$2,444.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,396.51
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| 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 |
$2,212.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.50
|
| Rate for Payer: Multiplan Commercial |
$9,166.50
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$12,222.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,444.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,396.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,388.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,722.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,388.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,388.70
|
| Rate for Payer: Dignity Health Senior |
$10,388.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,565.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,565.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,891.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.50
|
| Rate for Payer: Multiplan Commercial |
$9,166.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,388.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,388.70
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Blue Shield of California Commercial |
$167.67
|
| Rate for Payer: Blue Shield of California EPN |
$158.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
IP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$1,457.25 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,315.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,315.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
|
OP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$3,665.38 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,665.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,206.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.54
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,262.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Senior |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$936.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$18,891.75 |
| Rate for Payer: Adventist Health Commercial |
$5,037.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,184.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,304.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,591.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$678.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,559.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,297.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
OP
|
$18,226.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,184.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,281.89
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$678.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,141.35
|
| 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 |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$25,189.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906820235
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,559.21 |
| Max. Negotiated Rate |
$18,891.75 |
| Rate for Payer: Adventist Health Commercial |
$5,037.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,304.84
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Cash Price |
$11,335.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,559.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,297.25
|
| Rate for Payer: Multiplan Commercial |
$18,891.75
|
|
|
HC PTCA SINGLER VESSEL
|
Facility
|
IP
|
$18,226.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
906811432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,298.91 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: Dignity Health Senior |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN OT
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905104212
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$185.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.10
|
| Rate for Payer: Dignity Health Senior |
$243.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.03
|
| Rate for Payer: Heritage Provider Network Senior |
$177.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$137.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Vantage Medical Group Senior |
$243.10
|
|
|
HC PT ED GRP 2-5 PTS 60 MIN PT
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 97650
|
| Hospital Charge Code |
905103212
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Adventist Health Commercial |
$57.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$196.48
|
| Rate for Payer: Cash Price |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.62
|
| Rate for Payer: Heritage Provider Network Senior |
$193.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.50
|
| Rate for Payer: Multiplan Commercial |
$214.50
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
IP
|
$345.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.56
|
| Rate for Payer: Heritage Provider Network Senior |
$233.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
|
|
HC PT EVALUATION PRELIM MCAL
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
900400022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.25
|
| Rate for Payer: Dignity Health Senior |
$293.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.25
|
| Rate for Payer: Vantage Medical Group Senior |
$293.25
|
|
