|
HC PARASITE SCREEN
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
900911729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$15.76
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC PARASITE SCREEN
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
900911729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC PARATHYROID WITH PLANAR
|
Facility
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 78072
|
| Hospital Charge Code |
900078072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$215.93 |
| Max. Negotiated Rate |
$894.75 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$819.59
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$807.66
|
| Rate for Payer: Heritage Provider Network Senior |
$807.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.25
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
|
|
HC PARATHYROID WITH PLANAR
|
Facility
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 78072
|
| Hospital Charge Code |
900078072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$215.93 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$667.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$819.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$740.85
|
| Rate for Payer: Blue Shield of California EPN |
$700.29
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cash Price |
$536.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$775.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$738.47
|
| Rate for Payer: Heritage Provider Network Senior |
$738.47
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$569.28
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$894.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
IP
|
$41,006.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$30,754.50 |
| Rate for Payer: Adventist Health Commercial |
$8,201.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,171.12
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cash Price |
$18,452.70
|
| 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 |
$7,422.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,251.50
|
| Rate for Payer: Multiplan Commercial |
$30,754.50
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
OP
|
$41,006.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$30,754.50 |
| Rate for Payer: Adventist Health Commercial |
$8,201.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21,917.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,171.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,653.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,382.71
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,422.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,251.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$30,754.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,034.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,249.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,694.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,559.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
OP
|
$7,430.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,436.00 |
| Rate for Payer: Adventist Health Commercial |
$1,486.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,104.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,343.50
|
| Rate for Payer: Cash Price |
$3,343.50
|
| Rate for Payer: Cash Price |
$3,343.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,829.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,829.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,030.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,030.11
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,581.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,344.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,857.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$5,572.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,697.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,482.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
IP
|
$7,430.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,344.83 |
| Max. Negotiated Rate |
$5,572.50 |
| Rate for Payer: Adventist Health Commercial |
$1,486.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,104.41
|
| Rate for Payer: Cash Price |
$3,343.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,030.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,030.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,344.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,857.50
|
| Rate for Payer: Multiplan Commercial |
$5,572.50
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
OP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$153.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$178.85
|
| Rate for Payer: Blue Shield of California EPN |
$169.06
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Senior |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
IP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$211.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$178.85
|
| Rate for Payer: Blue Shield of California EPN |
$169.06
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Senior |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PCI BYPASS GRAFT
|
Facility
IP
|
$15,662.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,834.82 |
| Max. Negotiated Rate |
$11,746.50 |
| Rate for Payer: Adventist Health Commercial |
$3,132.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,759.79
|
| Rate for Payer: Cash Price |
$7,047.90
|
| Rate for Payer: Cash Price |
$7,047.90
|
| 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 |
$2,834.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,915.50
|
| Rate for Payer: Multiplan Commercial |
$11,746.50
|
|
|
HC PCI BYPASS GRAFT
|
Facility
OP
|
$15,662.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906820243
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,132.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,313.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,759.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$7,047.90
|
| Rate for Payer: Cash Price |
$7,047.90
|
| Rate for Payer: Cash Price |
$7,047.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,694.78
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$752.64
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,834.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,915.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$11,746.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| 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 PCI BYPASS GRAFT
|
Facility
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$752.64 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,313.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$752.64
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,359.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| 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 PCI BYPASS GRAFT
|
Facility
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92937
|
| Hospital Charge Code |
906811440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,359.90 |
| Max. Negotiated Rate |
$13,922.25 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: Cash Price |
$8,353.35
|
| Rate for Payer: Cash Price |
$8,353.35
|
| 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 |
$3,359.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,640.75
|
| Rate for Payer: Multiplan Commercial |
$13,922.25
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,435.95 |
| Max. Negotiated Rate |
$18,381.00 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| 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 |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
IP
|
$28,104.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$21,078.00 |
| Rate for Payer: Adventist Health Commercial |
$5,620.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,307.45
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| 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 |
$5,086.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,026.00
|
| Rate for Payer: Multiplan Commercial |
$21,078.00
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906811464
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$20,831.80 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,099.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,831.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,479.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,381.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cash Price |
$11,028.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,930.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,831.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,831.80
|
| Rate for Payer: Dignity Health Senior |
$20,831.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,930.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,170.45
|
| Rate for Payer: Heritage Provider Network Senior |
$15,170.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,812.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,831.80
|
| Rate for Payer: Vantage Medical Group Senior |
$20,831.80
|
|
|
HC PCI BYPASS GRAFT ADD
|
Facility
OP
|
$28,104.00
|
|
|
Service Code
|
CPT C9605
|
| Hospital Charge Code |
906820262
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$23,888.40 |
| Rate for Payer: Adventist Health Commercial |
$5,620.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15,021.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,307.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23,888.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,457.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,078.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cash Price |
$12,646.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,267.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,888.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,888.40
|
| Rate for Payer: Dignity Health Senior |
$23,888.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,267.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,396.38
|
| Rate for Payer: Heritage Provider Network Senior |
$17,396.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,546.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,086.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,026.00
|
| Rate for Payer: Multiplan Commercial |
$21,078.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,888.40
|
| Rate for Payer: Vantage Medical Group Senior |
$23,888.40
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
OP
|
$7,831.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$851.30 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,566.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,379.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,656.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,307.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,873.25
|
| 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 |
$3,523.95
|
| Rate for Payer: Cash Price |
$3,523.95
|
| Rate for Payer: Cash Price |
$3,523.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,656.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,656.35
|
| Rate for Payer: Dignity Health Senior |
$6,656.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,847.39
|
| Rate for Payer: Heritage Provider Network Senior |
$4,847.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,774.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,417.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.75
|
| Rate for Payer: Multiplan Commercial |
$5,873.25
|
| 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 |
$6,656.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6,656.35
|
|
