|
HC PTA ILIAC EA ADDL
|
Facility
IP
|
$14,033.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,539.97 |
| Max. Negotiated Rate |
$10,524.75 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,500.34
|
| Rate for Payer: Heritage Provider Network Senior |
$9,500.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.08 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| 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: IEHP Medi-Cal |
$250.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| 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
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTA ILIAC EA ADDL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
906820146
|
|
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: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| 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 INTRACRAN VASO EA ADD DIFF
|
Facility
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,113.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,955.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,394.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,113.20
|
| Rate for Payer: Dignity Health Senior |
$6,113.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$4,451.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,466.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| 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 |
$6,113.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,113.20
|
|
|
HC PTA INTRACRAN VASO EA ADD DIFF
|
Facility
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 61642
|
| Hospital Charge Code |
909081017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
OP
|
$8,271.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,497.05 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,654.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,682.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,030.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,549.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,203.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$3,721.95
|
| Rate for Payer: Cash Price |
$3,721.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,376.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,030.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,030.35
|
| Rate for Payer: Dignity Health Senior |
$7,030.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,962.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,119.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,119.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,986.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.75
|
| Rate for Payer: Multiplan Commercial |
$6,203.25
|
| 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 |
$7,030.35
|
| Rate for Payer: Vantage Medical Group Senior |
$7,030.35
|
|
|
HC PTA INTRACRAN VASOPAMS EA ADDL
|
Facility
IP
|
$8,271.00
|
|
|
Service Code
|
CPT 61641
|
| Hospital Charge Code |
909081016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,497.05 |
| Max. Negotiated Rate |
$6,203.25 |
| Rate for Payer: Adventist Health Commercial |
$1,654.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,682.18
|
| Rate for Payer: Cash Price |
$3,721.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,599.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5,599.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.75
|
| Rate for Payer: Multiplan Commercial |
$6,203.25
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
IP
|
$24,765.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,482.46 |
| Max. Negotiated Rate |
$18,573.75 |
| Rate for Payer: Adventist Health Commercial |
$4,953.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,013.56
|
| Rate for Payer: Cash Price |
$11,144.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,765.90
|
| Rate for Payer: Heritage Provider Network Senior |
$16,765.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,482.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,191.25
|
| Rate for Payer: Multiplan Commercial |
$18,573.75
|
|
|
HC PTA INTRACRAN VASOSPASM
|
Facility
OP
|
$24,765.00
|
|
|
Service Code
|
CPT 61640
|
| Hospital Charge Code |
909081015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$21,050.25 |
| Rate for Payer: Adventist Health Commercial |
$4,953.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,013.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,050.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,620.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,573.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| 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 |
$11,144.25
|
| Rate for Payer: Cash Price |
$11,144.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,097.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,050.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,050.25
|
| Rate for Payer: Dignity Health Senior |
$21,050.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,859.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,329.54
|
| Rate for Payer: Heritage Provider Network Senior |
$15,329.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,936.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,482.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,191.25
|
| Rate for Payer: Multiplan Commercial |
$18,573.75
|
| 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 |
$21,050.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21,050.25
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
OP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$2,873.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,870.82
|
| 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 |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,339.20
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,893.79
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$741.39
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.00
|
| 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 |
$10,776.00
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 PTA TIBIOPERONEAL
|
Facility
IP
|
$14,368.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
906820152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,600.61 |
| Max. Negotiated Rate |
$10,776.00 |
| Rate for Payer: Adventist Health Commercial |
$2,873.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,870.82
|
| Rate for Payer: Cash Price |
$6,465.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,727.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9,727.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.00
|
| Rate for Payer: Multiplan Commercial |
$10,776.00
|
|
|
HC PTA TIBIOPERONEAL
|
Facility
OP
|
$14,630.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.39 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$2,926.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,050.81
|
| 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 |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,583.50
|
| Rate for Payer: Cash Price |
$6,583.50
|
| Rate for Payer: Cash Price |
$6,583.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,509.50
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,055.97
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$741.39
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,648.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,657.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$10,972.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| 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 PTA TIBIOPERONEAL
|
Facility
IP
|
$14,630.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,648.03 |
| Max. Negotiated Rate |
$10,972.50 |
| Rate for Payer: Adventist Health Commercial |
$2,926.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,050.81
|
| Rate for Payer: Cash Price |
$6,583.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,904.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9,904.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,648.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,657.50
|
| Rate for Payer: Multiplan Commercial |
$10,972.50
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$14,033.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,539.97 |
| Max. Negotiated Rate |
$10,524.75 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,500.34
|
| Rate for Payer: Heritage Provider Network Senior |
$9,500.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$14,033.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
909020073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,806.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,640.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,928.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,718.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,524.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cash Price |
$6,314.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,121.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,928.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,928.05
|
| Rate for Payer: Dignity Health Senior |
$11,928.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,686.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,686.43
|
| Rate for Payer: IEHP Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,763.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,539.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,508.25
|
| Rate for Payer: Multiplan Commercial |
$10,524.75
|
| 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 |
$11,928.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,928.05
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,917.72 |
| Max. Negotiated Rate |
$12,090.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,913.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,913.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
|
|
HC PTA TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
906820156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.96 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,090.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,478.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: Dignity Health Senior |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,978.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9,978.28
|
| Rate for Payer: IEHP Medi-Cal |
$267.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,769.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| 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 |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
IP
|
$12,222.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,212.18 |
| Max. Negotiated Rate |
$9,166.50 |
| Rate for Payer: Adventist Health Commercial |
$2,444.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,396.51
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.50
|
| Rate for Payer: Multiplan Commercial |
$9,166.50
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
OP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,016.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,422.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,485.50
|
| 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 |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| 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 |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,479.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,479.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,381.35
|
| 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
|
| 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 |
$13,016.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13,016.90
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
OP
|
$12,222.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906811433
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.69 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,444.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$729.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,396.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,388.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,722.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,166.50
|
| 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 |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cash Price |
$5,499.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,388.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,388.70
|
| Rate for Payer: Dignity Health Senior |
$10,388.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,565.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,565.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,891.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.50
|
| Rate for Payer: Multiplan Commercial |
$9,166.50
|
| 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 |
$10,388.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,388.70
|
|
|
HC PTCA EA ADD'L VESSEL
|
Facility
IP
|
$15,314.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
906820236
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,771.83 |
| Max. Negotiated Rate |
$11,485.50 |
| Rate for Payer: Adventist Health Commercial |
$3,062.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,520.72
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Cash Price |
$6,891.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,771.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,828.50
|
| Rate for Payer: Multiplan Commercial |
$11,485.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Blue Shield of California Commercial |
$167.67
|
| Rate for Payer: Blue Shield of California EPN |
$158.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$130.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC PTCA EX BENT TIP RTRVAL SHEATH
|
Facility
IP
|
$270.00
|
|
| Hospital Charge Code |
909081432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
OP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$3,665.38 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,665.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,651.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,068.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,457.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,206.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.54
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,262.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,651.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,651.55
|
| Rate for Payer: Dignity Health Senior |
$1,651.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,202.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,202.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$936.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,651.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,651.55
|
|
|
HC PTCA FILTER WIRE EX(E.P.S.)
|
Facility
IP
|
$1,943.00
|
|
|
Service Code
|
CPT C1884
|
| Hospital Charge Code |
909081431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.68 |
| Max. Negotiated Rate |
$1,457.25 |
| Rate for Payer: Adventist Health Commercial |
$388.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.84
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,315.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,315.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.75
|
| Rate for Payer: Multiplan Commercial |
$1,457.25
|
|
