|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$30,825.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$26,201.25 |
| Rate for Payer: Adventist Health Commercial |
$6,165.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,475.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,176.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,201.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,953.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,118.75
|
| 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 |
$16,953.75
|
| Rate for Payer: Cash Price |
$16,953.75
|
| Rate for Payer: Cash Price |
$16,953.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,036.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,201.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,201.25
|
| Rate for Payer: Dignity Health Senior |
$26,201.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,036.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,080.67
|
| Rate for Payer: Heritage Provider Network Senior |
$19,080.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,703.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,579.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,706.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,577.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,577.50
|
| Rate for Payer: Multiplan Commercial |
$23,118.75
|
| 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 |
$26,201.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,201.25
|
| Rate for Payer: Vantage Medical Group Senior |
$26,201.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
OP
|
$36,885.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$31,352.25 |
| Rate for Payer: Adventist Health Commercial |
$7,377.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19,715.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,339.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,352.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,286.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27,663.75
|
| 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 |
$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 |
$31,352.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,352.25
|
| Rate for Payer: Dignity Health Senior |
$31,352.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,975.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,831.81
|
| Rate for Payer: Heritage Provider Network Senior |
$22,831.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,594.15
|
| 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: Molina Healthcare of CA Medi-Cal |
$25,819.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25,819.50
|
| Rate for Payer: Multiplan Commercial |
$27,663.75
|
| 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 |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,352.25
|
| Rate for Payer: Vantage Medical Group Senior |
$31,352.25
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
|
IP
|
$30,825.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,118.75 |
| Rate for Payer: Adventist Health Commercial |
$6,165.00
|
| Rate for Payer: Cash Price |
$16,953.75
|
| Rate for Payer: Cash Price |
$16,953.75
|
| 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 |
$5,579.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,706.25
|
| Rate for Payer: Multiplan Commercial |
$23,118.75
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$22,319.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$876.71 |
| Max. Negotiated Rate |
$18,971.15 |
| Rate for Payer: Adventist Health Commercial |
$4,463.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,929.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,333.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,971.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,275.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,739.25
|
| 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 |
$12,275.45
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,971.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,971.15
|
| Rate for Payer: Dignity Health Senior |
$18,971.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,815.46
|
| Rate for Payer: Heritage Provider Network Senior |
$13,815.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$876.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,646.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,039.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,579.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,623.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,623.30
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
| 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 |
$18,971.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,971.15
|
| Rate for Payer: Vantage Medical Group Senior |
$18,971.15
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$22,319.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906820245
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,039.74 |
| Max. Negotiated Rate |
$16,739.25 |
| Rate for Payer: Adventist Health Commercial |
$4,463.80
|
| Rate for Payer: Cash Price |
$12,275.45
|
| Rate for Payer: Cash Price |
$12,275.45
|
| 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 |
$4,039.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,579.75
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
IP
|
$15,843.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,867.58 |
| Max. Negotiated Rate |
$11,882.25 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| 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 |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
|
OP
|
$15,843.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$876.71 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,468.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,884.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,713.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,882.25
|
| 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 |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cash Price |
$8,713.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,466.55
|
| Rate for Payer: Dignity Health Senior |
$13,466.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,806.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9,806.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$876.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,557.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,090.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,090.10
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
| 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 |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,466.55
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$20,918.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| 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 |
$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 |
$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 |
$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 |
$13,596.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,948.24
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| 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 |
$3,786.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,229.50
|
| 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 |
$15,688.50
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| 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 PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$20,918.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906811463
|
|
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 PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
IP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$25,029.75 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| 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 |
$6,040.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,343.25
|
| Rate for Payer: Multiplan Commercial |
$25,029.75
|
|
|
HC PCI PERCUTANEOUS CORONARY INTERVENTION BYPASS GRAFT
|
Facility
|
OP
|
$33,373.00
|
|
|
Service Code
|
CPT C9604
|
| Hospital Charge Code |
906820261
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$6,674.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,927.25
|
| 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 |
$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 |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cash Price |
$18,355.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,692.45
|
| 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 |
$21,692.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,657.89
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| 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 |
$6,040.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,343.25
|
| 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 |
$25,029.75
|
| 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 |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| 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 PDL TUBE
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC PDL TUBE
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
900800709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Blue Shield of California Commercial |
$128.10
|
| Rate for Payer: Blue Shield of California EPN |
$102.48
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Senior |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Blue Shield of California Commercial |
$150.06
|
| Rate for Payer: Blue Shield of California EPN |
$120.05
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Senior |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$123.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC PEEL AWAY INTRODUCER SET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.77 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$792.09
|
| Rate for Payer: Heritage Provider Network Senior |
$792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$625.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$803.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$325.78
|
| Rate for Payer: Blue Shield of California EPN |
$261.98
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,669.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,536.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.87
|
| Rate for Payer: Heritage Provider Network Senior |
$362.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$286.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$368.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$455.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.80
|
| Rate for Payer: Blue Shield of California Commercial |
$326.96
|
| Rate for Payer: Blue Shield of California EPN |
$261.57
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Cash Price |
$294.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$348.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$455.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$455.60
|
| Rate for Payer: Dignity Health Senior |
$455.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.78
|
| Rate for Payer: Heritage Provider Network Senior |
$331.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$255.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$375.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$455.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$455.60
|
| Rate for Payer: Vantage Medical Group Senior |
$455.60
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.67 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$125.60
|
| Rate for Payer: Cash Price |
$345.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$425.16
|
| Rate for Payer: Heritage Provider Network Senior |
$425.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Multiplan Commercial |
$471.00
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$125.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$335.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$431.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$345.40
|
| Rate for Payer: Cash Price |
$345.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$408.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.73
|
| Rate for Payer: Heritage Provider Network Senior |
$388.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$299.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$471.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$541.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$483.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
