|
HC PERM DIALYSIS CATH
|
Facility
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$766.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.53
|
| Rate for Payer: Heritage Provider Network Senior |
$755.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$558.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$372.86
|
|
|
HC PERM DIALYSIS CATH
|
Facility
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$766.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$837.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$693.04
|
| Rate for Payer: Blue Shield of California EPN |
$655.09
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$513.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: Dignity Health Senior |
$948.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.71
|
| Rate for Payer: Heritage Provider Network Senior |
$516.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$558.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$372.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PEROXIDASE STAIN
|
Facility
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$195.48 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Adventist Health Commercial |
$216.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$741.96
|
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.16
|
| Rate for Payer: Heritage Provider Network Senior |
$731.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
|
|
HC PEROXIDASE STAIN
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.01 |
| Max. Negotiated Rate |
$2,041.30 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$266.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.01
|
| Rate for Payer: Blue Shield of California Commercial |
$243.43
|
| Rate for Payer: Blue Shield of California EPN |
$230.10
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: Dignity Health Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,074.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Humana Medicare |
$1,074.37
|
| Rate for Payer: IEHP Medi-Cal |
$107.30
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,041.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,267.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,353.71
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,074.37
|
| Rate for Payer: TriValley Medical Group Senior |
$1,074.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$722.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
IP
|
$18,817.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,405.88 |
| Max. Negotiated Rate |
$14,112.75 |
| Rate for Payer: Adventist Health Commercial |
$3,763.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,927.28
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,739.11
|
| Rate for Payer: Heritage Provider Network Senior |
$12,739.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,405.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,704.25
|
| Rate for Payer: Multiplan Commercial |
$14,112.75
|
|
|
HC PERQ ABLTJ LIVER CRYOABLATION
|
Facility
OP
|
$18,817.00
|
|
|
Service Code
|
CPT 47383
|
| Hospital Charge Code |
909047383
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.49 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Adventist Health Commercial |
$3,763.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,995.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,927.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Cash Price |
$8,467.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,231.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,647.72
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: IEHP Medi-Cal |
$650.49
|
| Rate for Payer: IEHP Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,405.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,704.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$14,112.75
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| 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 |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
IP
|
$15,500.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,805.50 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,648.50
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,875.00
|
| Rate for Payer: Multiplan Commercial |
$11,625.00
|
|
|
HC PERQ CERVICOTHORACIC INJECT
|
Facility
OP
|
$15,500.00
|
|
|
Service Code
|
CPT 22510
|
| Hospital Charge Code |
909022510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.47 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,648.50
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,075.00
|
| 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 |
$9,594.50
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$614.47
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,875.00
|
| 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 |
$11,625.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 PERQ IMPL OF NEUROSTIM ELECT
|
Facility
OP
|
$22,519.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
900100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$16,889.25 |
| Rate for Payer: Adventist Health Commercial |
$4,503.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,470.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,817.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,399.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,545.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$10,133.55
|
| Rate for Payer: Cash Price |
$10,133.55
|
| Rate for Payer: Cash Price |
$10,133.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,637.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,817.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,399.57
|
| Rate for Payer: Dignity Health Senior |
$8,545.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,511.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,545.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,939.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,510.42
|
| Rate for Payer: Humana Medicare |
$8,545.06
|
| Rate for Payer: IEHP Medi-Cal |
$135.91
|
| Rate for Payer: IEHP Medicare Advantage |
$8,545.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,235.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,075.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,083.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,629.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,766.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,766.78
|
| Rate for Payer: Multiplan Commercial |
$16,889.25
|
| Rate for Payer: Multiplan WC |
$11,682.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,399.57
|
| Rate for Payer: TriValley Medical Group Senior |
$9,399.57
|
| 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 |
$12,817.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,399.57
|
| Rate for Payer: Vantage Medical Group Senior |
$8,545.06
|
|
|
HC PERQ IMPL OF NEUROSTIM ELECT
|
Facility
IP
|
$22,519.00
|
|
|
Service Code
|
CPT 63650
|
| Hospital Charge Code |
900100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,075.94 |
| Max. Negotiated Rate |
$16,889.25 |
| Rate for Payer: Adventist Health Commercial |
$4,503.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,470.55
|
| Rate for Payer: Cash Price |
$10,133.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,245.36
|
| Rate for Payer: Heritage Provider Network Senior |
$15,245.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,075.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,629.75
|
| Rate for Payer: Multiplan Commercial |
$16,889.25
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
IP
|
$15,500.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,805.50 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,100.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,648.50
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,319.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,928.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,875.00
|
| Rate for Payer: Multiplan Commercial |
$11,625.00
|
|
|
HC PERQ LUMBOSACRAL INJECT
|
Facility
OP
|
$15,500.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
909022511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.31 |
| Max. Negotiated Rate |
$11,625.00 |
| Rate for Payer: Adventist Health Commercial |
$3,100.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,648.50
|
| 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 |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cash Price |
$6,975.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,075.00
|
| 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 |
$9,594.50
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$577.31
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,805.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,875.00
|
| 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 |
$11,625.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 PERQ PRCRD DRG INS CATH CT GDN
|
Facility
IP
|
$2,223.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$1,667.25 |
| Rate for Payer: Adventist Health Commercial |
$444.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,527.20
|
| Rate for Payer: Cash Price |
$1,000.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,504.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,504.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.75
|
| Rate for Payer: Multiplan Commercial |
$1,667.25
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
OP
|
$2,223.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.78 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$444.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,527.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,889.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,222.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,667.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,000.35
|
| Rate for Payer: Cash Price |
$1,000.35
|
| Rate for Payer: Cash Price |
$1,000.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,444.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,889.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,889.55
|
| Rate for Payer: Dignity Health Senior |
$1,889.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,376.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,376.04
|
| Rate for Payer: IEHP Medi-Cal |
$301.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,071.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.75
|
| Rate for Payer: Multiplan Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,889.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,889.55
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
IP
|
$26,336.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,766.82 |
| Max. Negotiated Rate |
$19,752.00 |
| Rate for Payer: Adventist Health Commercial |
$5,267.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,092.83
|
| Rate for Payer: Cash Price |
$11,851.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,829.47
|
| Rate for Payer: Heritage Provider Network Senior |
$17,829.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,766.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,584.00
|
| Rate for Payer: Multiplan Commercial |
$19,752.00
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
OP
|
$26,336.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$22,385.60 |
| Rate for Payer: Adventist Health Commercial |
$5,267.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,092.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22,385.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14,484.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19,752.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| 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 |
$11,851.20
|
| Rate for Payer: Cash Price |
$11,851.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,385.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,385.60
|
| Rate for Payer: Dignity Health Senior |
$22,385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,801.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,301.98
|
| Rate for Payer: Heritage Provider Network Senior |
$16,301.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,693.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,766.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,584.00
|
| Rate for Payer: Multiplan Commercial |
$19,752.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,385.60
|
| Rate for Payer: Vantage Medical Group Senior |
$22,385.60
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
IP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$36,240.75 |
| Rate for Payer: Adventist Health Commercial |
$9,664.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,196.53
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| 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 |
$8,746.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,080.25
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
OP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$881.81 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,196.53
|
| 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 |
$8,576.00
|
| 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 |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$31,408.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,910.70
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$881.81
|
| 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 |
$8,746.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,080.25
|
| 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 |
$36,240.75
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| 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 PERQ TRANSCATH CLOSURE PDA
|
Facility
OP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$881.81 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,664.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,196.53
|
| 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 |
$8,576.00
|
| 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 |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$31,408.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,910.70
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$881.81
|
| 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 |
$8,746.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,080.25
|
| 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 |
$36,240.75
|
| 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 |
$17,865.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,024.00
|
| 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 PERQ TRANSCATH CLOSURE PDA
|
Facility
IP
|
$48,321.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906820005
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$36,240.75 |
| Rate for Payer: Adventist Health Commercial |
$9,664.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,196.53
|
| Rate for Payer: Cash Price |
$21,744.45
|
| Rate for Payer: Cash Price |
$21,744.45
|
| 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 |
$8,746.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,080.25
|
| Rate for Payer: Multiplan Commercial |
$36,240.75
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,302.79 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,155.58
|
| 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 |
$8,576.00
|
| 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 |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$32,316.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,774.82
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$1,302.79
|
| 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 |
$8,998.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,429.25
|
| 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 |
$37,287.75
|
| 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 |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| 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 PERQ TRANSCATH CLS AORTIC
|
Facility
IP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
906820092
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$37,287.75 |
| Rate for Payer: Adventist Health Commercial |
$9,943.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,155.58
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| 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 |
$8,998.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,429.25
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
IP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$37,287.75 |
| Rate for Payer: Adventist Health Commercial |
$9,943.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,155.58
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| 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 |
$8,998.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,429.25
|
| Rate for Payer: Multiplan Commercial |
$37,287.75
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
OP
|
$49,717.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,302.79 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,943.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,155.58
|
| 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 |
$8,576.00
|
| 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 |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cash Price |
$22,372.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$32,316.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$30,774.82
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$1,302.79
|
| 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 |
$8,998.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,429.25
|
| 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 |
$37,287.75
|
| 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 |
$18,042.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,173.00
|
| 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 PERQ TRANSCATH CLSRE MITRAL
|
Facility
IP
|
$38,956.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906820301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$29,217.00 |
| Rate for Payer: Adventist Health Commercial |
$7,791.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,762.77
|
| Rate for Payer: Cash Price |
$17,530.20
|
| Rate for Payer: Cash Price |
$17,530.20
|
| 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 |
$7,051.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,739.00
|
| Rate for Payer: Multiplan Commercial |
$29,217.00
|
|
