|
HC PCI BYPASS GRAFT ADD
|
Facility
|
OP
|
$26,699.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$22,694.15 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,270.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,342.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,684.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,024.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,354.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,694.15
|
| Rate for Payer: Dignity Health Senior |
$22,694.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,354.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,526.68
|
| Rate for Payer: Heritage Provider Network Senior |
$16,526.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,735.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,832.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,689.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,689.30
|
| Rate for Payer: Multiplan Commercial |
$20,024.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,694.15
|
| Rate for Payer: Vantage Medical Group Senior |
$22,694.15
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
IP
|
$26,699.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,832.52 |
| Max. Negotiated Rate |
$20,024.25 |
| Rate for Payer: Adventist Health Commercial |
$5,339.80
|
| Rate for Payer: Cash Price |
$14,684.45
|
| Rate for Payer: Cash Price |
$14,684.45
|
| 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 |
$4,832.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.75
|
| Rate for Payer: Multiplan Commercial |
$20,024.25
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$17,780.30 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,180.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,370.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,780.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,504.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,688.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,780.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,780.30
|
| Rate for Payer: Dignity Health Senior |
$17,780.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,596.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$12,948.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,977.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,642.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,642.60
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,780.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,780.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17,780.30
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,786.16 |
| Max. Negotiated Rate |
$15,688.50 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| 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 |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
IP
|
$6,323.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,144.46 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.60
|
| Rate for Payer: Cash Price |
$3,477.65
|
| Rate for Payer: Cash Price |
$3,477.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,580.75
|
| Rate for Payer: Multiplan Commercial |
$4,742.25
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
IP
|
$7,439.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,346.46 |
| Max. Negotiated Rate |
$5,579.25 |
| Rate for Payer: Adventist Health Commercial |
$1,487.80
|
| Rate for Payer: Cash Price |
$4,091.45
|
| Rate for Payer: Cash Price |
$4,091.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,346.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,859.75
|
| Rate for Payer: Multiplan Commercial |
$5,579.25
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
OP
|
$6,323.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,343.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,374.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,477.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,742.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,477.65
|
| Rate for Payer: Cash Price |
$3,477.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,374.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,374.55
|
| Rate for Payer: Dignity Health Senior |
$5,374.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,913.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,913.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,016.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,580.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,426.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,426.10
|
| Rate for Payer: Multiplan Commercial |
$4,742.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,374.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,374.55
|
| Rate for Payer: Vantage Medical Group Senior |
$5,374.55
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
|
OP
|
$7,439.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,487.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,110.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,091.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,579.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,091.45
|
| Rate for Payer: Cash Price |
$4,091.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,323.15
|
| Rate for Payer: Dignity Health Senior |
$6,323.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,604.74
|
| Rate for Payer: Heritage Provider Network Senior |
$4,604.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,548.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,346.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,859.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,207.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,207.30
|
| Rate for Payer: Multiplan Commercial |
$5,579.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,323.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,323.15
|
| Rate for Payer: Vantage Medical Group Senior |
$6,323.15
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
IP
|
$15,177.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,747.04 |
| Max. Negotiated Rate |
$11,382.75 |
| Rate for Payer: Adventist Health Commercial |
$3,035.40
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,794.25
|
| Rate for Payer: Multiplan Commercial |
$11,382.75
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
OP
|
$17,855.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,571.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,266.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,820.25
|
| Rate for Payer: Cash Price |
$9,820.25
|
| Rate for Payer: Cash Price |
$9,820.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,052.25
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$876.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,231.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$13,391.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
IP
|
$17,855.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,231.76 |
| Max. Negotiated Rate |
$13,391.25 |
| Rate for Payer: Adventist Health Commercial |
$3,571.00
|
| Rate for Payer: Cash Price |
$9,820.25
|
| Rate for Payer: Cash Price |
$9,820.25
|
| 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 |
$3,231.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.75
|
| Rate for Payer: Multiplan Commercial |
$13,391.25
|
|
|
HC PCI CORO/BYPASS CHRONIC 1 VESL
|
Facility
|
OP
|
$15,177.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,035.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,426.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cash Price |
$8,347.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,394.56
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$876.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,747.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,794.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$11,382.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,370.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,596.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,596.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$3,786.16 |
| Max. Negotiated Rate |
$15,688.50 |
| Rate for Payer: Adventist Health Commercial |
$4,183.60
|
| Rate for Payer: Cash Price |
$11,504.90
|
| Rate for Payer: Cash Price |
$11,504.90
|
| 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 |
$3,786.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| Rate for Payer: Multiplan Commercial |
$15,688.50
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,663.75 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,676.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,221.25
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,339.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,975.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,975.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,831.81
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,676.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,221.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$22,815.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$26,346.00 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,358.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.00
|
| Rate for Payer: Multiplan Commercial |
$26,346.00
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
IP
|
$26,769.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,845.19 |
| Max. Negotiated Rate |
$20,076.75 |
| Rate for Payer: Adventist Health Commercial |
$5,353.80
|
| Rate for Payer: Cash Price |
$14,722.95
|
| Rate for Payer: Cash Price |
$14,722.95
|
| 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 |
$4,845.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,692.25
|
| Rate for Payer: Multiplan Commercial |
$20,076.75
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$35,128.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$29,858.80 |
| Rate for Payer: Adventist Health Commercial |
$7,025.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,775.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24,132.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,320.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26,346.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Cash Price |
$19,320.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,833.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,858.80
|
| Rate for Payer: Dignity Health Senior |
$29,858.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,833.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,744.23
|
| Rate for Payer: Heritage Provider Network Senior |
$21,744.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,756.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,358.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,782.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,589.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,589.60
|
| Rate for Payer: Multiplan Commercial |
$26,346.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,858.80
|
| Rate for Payer: Vantage Medical Group Senior |
$29,858.80
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
|
OP
|
$26,769.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$22,753.65 |
| Rate for Payer: Adventist Health Commercial |
$5,353.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,308.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,390.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,753.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,722.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,076.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$14,722.95
|
| Rate for Payer: Cash Price |
$14,722.95
|
| Rate for Payer: Cash Price |
$14,722.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,399.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,753.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,753.65
|
| Rate for Payer: Dignity Health Senior |
$22,753.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,399.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,570.01
|
| Rate for Payer: Heritage Provider Network Senior |
$16,570.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,768.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,845.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,692.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,738.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,738.30
|
| Rate for Payer: Multiplan Commercial |
$20,076.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,753.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,753.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22,753.65
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$7,588.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,373.43 |
| Max. Negotiated Rate |
$5,691.00 |
| Rate for Payer: Adventist Health Commercial |
$1,517.60
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,373.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,897.00
|
| Rate for Payer: Multiplan Commercial |
$5,691.00
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,615.79 |
| Max. Negotiated Rate |
$6,695.25 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,231.75
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,785.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,132.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,909.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,695.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Cash Price |
$4,909.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,587.95
|
| Rate for Payer: Dignity Health Senior |
$7,587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,525.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,525.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,258.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,615.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,231.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,248.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,248.90
|
| Rate for Payer: Multiplan Commercial |
$6,695.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,587.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,587.95
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
|
OP
|
$7,588.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,517.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,212.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,173.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,691.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Cash Price |
$4,173.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,449.80
|
| Rate for Payer: Dignity Health Senior |
$6,449.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,696.97
|
| Rate for Payer: Heritage Provider Network Senior |
$4,696.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,619.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,373.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,897.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,311.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,311.60
|
| Rate for Payer: Multiplan Commercial |
$5,691.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,449.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,449.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,449.80
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,663.75 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Cash Price |
$20,286.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,676.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,221.25
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
|
