|
HC PTA FEM/POP
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
906820148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,367.58
|
| Rate for Payer: Heritage Provider Network Senior |
$10,367.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$14,610.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,644.41 |
| Max. Negotiated Rate |
$10,957.50 |
| Rate for Payer: Adventist Health Commercial |
$2,922.00
|
| Rate for Payer: Cash Price |
$8,035.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,890.97
|
| Rate for Payer: Heritage Provider Network Senior |
$9,890.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,644.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,652.50
|
| Rate for Payer: Multiplan Commercial |
$10,957.50
|
|
|
HC PTA ILIAC
|
Facility
|
IP
|
$13,126.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,375.81 |
| Max. Negotiated Rate |
$9,844.50 |
| Rate for Payer: Adventist Health Commercial |
$2,625.20
|
| Rate for Payer: Cash Price |
$7,219.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,886.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,886.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,281.50
|
| Rate for Payer: Multiplan Commercial |
$9,844.50
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$14,610.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
906820144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,922.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,037.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,035.50
|
| Rate for Payer: Cash Price |
$8,035.50
|
| Rate for Payer: Cash Price |
$8,035.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,496.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,043.59
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,644.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,652.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$10,957.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$13,126.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,625.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,017.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,219.30
|
| Rate for Payer: Cash Price |
$7,219.30
|
| Rate for Payer: Cash Price |
$7,219.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,531.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,124.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$572.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,375.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$9,844.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$11,977.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,228.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,587.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,982.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,785.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,180.45
|
| Rate for Payer: Dignity Health Senior |
$10,180.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,413.76
|
| Rate for Payer: Heritage Provider Network Senior |
$7,413.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,713.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,994.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,383.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,383.90
|
| Rate for Payer: Multiplan Commercial |
$8,982.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,180.45
|
| Rate for Payer: Vantage Medical Group Senior |
$10,180.45
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$11,977.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.84 |
| Max. Negotiated Rate |
$8,982.75 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,108.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,108.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,994.25
|
| Rate for Payer: Multiplan Commercial |
$8,982.75
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,994.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,456.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Senior |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,005.21
|
| Rate for Payer: Heritage Provider Network Senior |
$9,005.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,939.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
|
IP
|
$14,548.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,633.19 |
| Max. Negotiated Rate |
$10,911.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,849.00
|
| Rate for Payer: Heritage Provider Network Senior |
$9,849.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
IP
|
$9,512.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,721.67 |
| Max. Negotiated Rate |
$7,134.00 |
| Rate for Payer: Adventist Health Commercial |
$1,902.40
|
| Rate for Payer: Cash Price |
$5,231.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,439.62
|
| Rate for Payer: Heritage Provider Network Senior |
$6,439.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,721.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.00
|
| Rate for Payer: Multiplan Commercial |
$7,134.00
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
|
OP
|
$9,512.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,721.67 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,534.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,085.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,231.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,134.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,231.60
|
| Rate for Payer: Cash Price |
$5,231.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,182.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,085.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,085.20
|
| Rate for Payer: Dignity Health Senior |
$8,085.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,707.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,887.93
|
| Rate for Payer: Heritage Provider Network Senior |
$5,887.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,537.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,721.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,378.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,658.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,658.40
|
| Rate for Payer: Multiplan Commercial |
$7,134.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,085.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,085.20
|
| Rate for Payer: Vantage Medical Group Senior |
$8,085.20
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
OP
|
$10,939.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,979.96 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,187.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,515.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,298.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,016.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,204.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,016.45
|
| Rate for Payer: Cash Price |
$6,016.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,110.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,298.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,298.15
|
| Rate for Payer: Dignity Health Senior |
$9,298.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,563.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,771.24
|
| Rate for Payer: Heritage Provider Network Senior |
$6,771.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,217.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,979.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,734.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,657.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,657.30
|
| Rate for Payer: Multiplan Commercial |
$8,204.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,298.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,298.15
|
| Rate for Payer: Vantage Medical Group Senior |
$9,298.15
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
|
IP
|
$10,939.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,979.96 |
| Max. Negotiated Rate |
$8,204.25 |
| Rate for Payer: Adventist Health Commercial |
$2,187.80
|
| Rate for Payer: Cash Price |
$6,016.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,405.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,405.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,979.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,734.75
|
| Rate for Payer: Multiplan Commercial |
$8,204.25
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
IP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,429.98 |
| Max. Negotiated Rate |
$18,356.25 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Cash Price |
$13,461.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,569.58
|
| Rate for Payer: Heritage Provider Network Senior |
$16,569.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,429.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,118.75
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
|
OP
|
$24,475.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$20,803.75 |
| Rate for Payer: Adventist Health Commercial |
$4,895.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,814.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,461.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,356.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$13,461.25
|
| Rate for Payer: Cash Price |
$13,461.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,908.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,803.75
|
| Rate for Payer: Dignity Health Senior |
$20,803.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,685.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,150.02
|
| Rate for Payer: Heritage Provider Network Senior |
$15,150.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,674.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,429.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,118.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,132.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,132.50
|
| Rate for Payer: Multiplan Commercial |
$18,356.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,803.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,803.75
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$11,602.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,320.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,970.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,381.10
|
| Rate for Payer: Cash Price |
$6,381.10
|
| Rate for Payer: Cash Price |
$6,381.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,541.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,181.64
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$770.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,900.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$8,701.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
OP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,377.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,872.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,449.35
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$770.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$10,237.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$13,650.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.65 |
| Max. Negotiated Rate |
$10,237.50 |
| Rate for Payer: Adventist Health Commercial |
$2,730.00
|
| Rate for Payer: Cash Price |
$7,507.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,241.05
|
| Rate for Payer: Heritage Provider Network Senior |
$9,241.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.50
|
| Rate for Payer: Multiplan Commercial |
$10,237.50
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
|
IP
|
$11,602.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,099.96 |
| Max. Negotiated Rate |
$8,701.50 |
| Rate for Payer: Adventist Health Commercial |
$2,320.40
|
| Rate for Payer: Cash Price |
$6,381.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,854.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7,854.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,900.50
|
| Rate for Payer: Multiplan Commercial |
$8,701.50
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$11,977.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,228.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,587.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,982.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,785.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,180.45
|
| Rate for Payer: Dignity Health Senior |
$10,180.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,413.76
|
| Rate for Payer: Heritage Provider Network Senior |
$7,413.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,713.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,994.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,383.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,383.90
|
| Rate for Payer: Multiplan Commercial |
$8,982.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,180.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,180.45
|
| Rate for Payer: Vantage Medical Group Senior |
$10,180.45
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$11,977.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.84 |
| Max. Negotiated Rate |
$8,982.75 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Cash Price |
$6,587.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,108.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,108.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,994.25
|
| Rate for Payer: Multiplan Commercial |
$8,982.75
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,367.58
|
| Rate for Payer: Heritage Provider Network Senior |
$10,367.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
|
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cash Price |
$8,422.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,954.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,016.90
|
| Rate for Payer: Dignity Health Senior |
$13,016.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,304.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,719.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,719.80
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
IP
|
$10,431.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,888.01 |
| Max. Negotiated Rate |
$7,823.25 |
| Rate for Payer: Adventist Health Commercial |
$2,086.20
|
| Rate for Payer: Cash Price |
$5,737.05
|
| Rate for Payer: Cash Price |
$5,737.05
|
| 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 |
$1,888.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,607.75
|
| Rate for Payer: Multiplan Commercial |
$7,823.25
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
|
OP
|
$14,548.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,909.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,994.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,001.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,911.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cash Price |
$8,001.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,365.80
|
| Rate for Payer: Dignity Health Senior |
$12,365.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,005.21
|
| Rate for Payer: Heritage Provider Network Senior |
$9,005.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,939.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,633.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,637.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,183.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,183.60
|
| Rate for Payer: Multiplan Commercial |
$10,911.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,365.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,365.80
|
|
