|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
IP
|
$7,831.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906820244
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,417.41 |
| Max. Negotiated Rate |
$5,873.25 |
| Rate for Payer: Adventist Health Commercial |
$1,566.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,379.90
|
| Rate for Payer: Cash Price |
$3,523.95
|
| Rate for Payer: Cash Price |
$3,523.95
|
| 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 |
$1,417.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,957.75
|
| Rate for Payer: Multiplan Commercial |
$5,873.25
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$851.30 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| 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 |
$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 |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| 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
|
| 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 |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC PCI BYPASS GRAFT, ADDN'L
|
Facility
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92938
|
| Hospital Charge Code |
906811441
|
|
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 CORO/BYPASS CHRONIC 1 VESL
|
Facility
OP
|
$18,795.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.24 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,759.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,472.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,912.16
|
| 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 |
$8,457.75
|
| Rate for Payer: Cash Price |
$8,457.75
|
| Rate for Payer: Cash Price |
$8,457.75
|
| 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 |
$11,634.10
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$844.24
|
| 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 |
$3,401.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.75
|
| 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 |
$14,096.25
|
| 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 CORO/BYPASS CHRONIC 1 VESL
|
Facility
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
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 CORO/BYPASS CHRONIC 1 VESL
|
Facility
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906811443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.24 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,472.85
|
| 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 |
$844.24
|
| 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 CORO/BYPASS CHRONIC 1 VESL
|
Facility
IP
|
$18,795.00
|
|
|
Service Code
|
CPT 92943
|
| Hospital Charge Code |
906820246
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,401.90 |
| Max. Negotiated Rate |
$14,096.25 |
| Rate for Payer: Adventist Health Commercial |
$3,759.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,912.16
|
| Rate for Payer: Cash Price |
$8,457.75
|
| Rate for Payer: Cash Price |
$8,457.75
|
| 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 |
$3,401.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,698.75
|
| Rate for Payer: Multiplan Commercial |
$14,096.25
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
OP
|
$38,826.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,788.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,236.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,236.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,033.29
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,027.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| 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 Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$4,901.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,788.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,837.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,930.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,170.45
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,435.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,127.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$18,381.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$21,908.96
|
| 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 Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
IP
|
$38,826.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906820264
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,119.50 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| 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 |
$7,027.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
|
|
HC PCI CORO BYPASS CHRONIC 1 VSL
|
Facility
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9607
|
| Hospital Charge Code |
906811466
|
|
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 CORO BYPASS CHRONIC ADD
|
Facility
OP
|
$36,977.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$31,430.45 |
| Rate for Payer: Adventist Health Commercial |
$7,395.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19,764.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,403.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31,430.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20,337.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27,732.75
|
| 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 |
$16,639.65
|
| Rate for Payer: Cash Price |
$16,639.65
|
| Rate for Payer: Cash Price |
$16,639.65
|
| Rate for Payer: Cash Price |
$16,639.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24,035.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,430.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,430.45
|
| Rate for Payer: Dignity Health Senior |
$31,430.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,035.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,888.76
|
| Rate for Payer: Heritage Provider Network Senior |
$22,888.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,822.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,692.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,244.25
|
| Rate for Payer: Multiplan Commercial |
$27,732.75
|
| 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 |
$31,430.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31,430.45
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
IP
|
$36,977.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906820265
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$27,732.75 |
| Rate for Payer: Adventist Health Commercial |
$7,395.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,403.20
|
| Rate for Payer: Cash Price |
$16,639.65
|
| Rate for Payer: Cash Price |
$16,639.65
|
| 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 |
$6,692.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,244.25
|
| Rate for Payer: Multiplan Commercial |
$27,732.75
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
OP
|
$31,364.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$26,659.40 |
| Rate for Payer: Adventist Health Commercial |
$6,272.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,764.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,547.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26,659.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17,250.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,523.00
|
| 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 |
$14,113.80
|
| Rate for Payer: Cash Price |
$14,113.80
|
| Rate for Payer: Cash Price |
$14,113.80
|
| Rate for Payer: Cash Price |
$14,113.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,386.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,659.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,659.40
|
| Rate for Payer: Dignity Health Senior |
$26,659.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,386.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,414.32
|
| Rate for Payer: Heritage Provider Network Senior |
$19,414.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,117.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,676.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,841.00
|
| Rate for Payer: Multiplan Commercial |
$23,523.00
|
| 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 |
$26,659.40
|
| Rate for Payer: Vantage Medical Group Senior |
$26,659.40
|
|
|
HC PCI CORO BYPASS CHRONIC ADD
|
Facility
IP
|
$31,364.00
|
|
|
Service Code
|
CPT C9608
|
| Hospital Charge Code |
906811467
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$23,523.00 |
| Rate for Payer: Adventist Health Commercial |
$6,272.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,547.07
|
| Rate for Payer: Cash Price |
$14,113.80
|
| Rate for Payer: Cash Price |
$14,113.80
|
| 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 |
$5,676.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,841.00
|
| Rate for Payer: Multiplan Commercial |
$23,523.00
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,094.54 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,094.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| 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 |
$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 |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| 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
|
| 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 |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906811444
|
|
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 CORO/BYPASS CHRONIC, ADD'L
|
Facility
IP
|
$9,397.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,700.86 |
| Max. Negotiated Rate |
$7,047.75 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,455.74
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| 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 |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
|
|
HC PCI CORO/BYPASS CHRONIC, ADD'L
|
Facility
OP
|
$9,397.00
|
|
|
Service Code
|
CPT 92944
|
| Hospital Charge Code |
906820247
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,094.54 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,879.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,094.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,455.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,987.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,168.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,047.75
|
| 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 |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cash Price |
$4,228.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,987.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,987.45
|
| Rate for Payer: Dignity Health Senior |
$7,987.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,816.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,816.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,529.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,349.25
|
| Rate for Payer: Multiplan Commercial |
$7,047.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,987.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,987.45
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
OP
|
$24,508.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
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 |
$1,673.42
|
| 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 CORO BYPASS W MI 1 VESSEL
|
Facility
IP
|
$24,508.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906811465
|
|
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 CORO BYPASS W MI 1 VESSEL
|
Facility
IP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,119.50 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| 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 |
$7,027.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
|
|
HC PCI CORO BYPASS W MI 1 VESSEL
|
Facility
OP
|
$38,826.00
|
|
|
Service Code
|
CPT C9606
|
| Hospital Charge Code |
906820263
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$33,002.10 |
| Rate for Payer: Adventist Health Commercial |
$7,765.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,673.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,673.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33,002.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21,354.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29,119.50
|
| 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 |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cash Price |
$17,471.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,236.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,002.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,002.10
|
| Rate for Payer: Dignity Health Senior |
$33,002.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,236.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,033.29
|
| Rate for Payer: Heritage Provider Network Senior |
$24,033.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,714.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,027.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,706.50
|
| Rate for Payer: Multiplan Commercial |
$29,119.50
|
| 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 |
$33,002.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,002.10
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
OP
|
$18,563.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$844.24 |
| Max. Negotiated Rate |
$15,778.55 |
| Rate for Payer: Adventist Health Commercial |
$3,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,472.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,752.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,778.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,209.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,922.25
|
| 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 |
$15,778.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,778.55
|
| Rate for Payer: Dignity Health Senior |
$15,778.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,490.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,490.50
|
| Rate for Payer: IEHP Medi-Cal |
$844.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,947.37
|
| 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
|
| 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 |
$15,778.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15,778.55
|
|
|
HC PCI CORO/BYPASS W MI, 1 VESSEL
|
Facility
IP
|
$18,563.00
|
|
|
Service Code
|
CPT 92941
|
| Hospital Charge Code |
906811442
|
|
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
|
|
