|
HC PROTHROMBIN TIME QUICK
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
900910040
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.57
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.59
|
| Rate for Payer: Heritage Provider Network Senior |
$82.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.50
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$227.16 |
| Max. Negotiated Rate |
$941.25 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$775.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$479.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$627.75
|
| Rate for Payer: Blue Shield of California Commercial |
$580.03
|
| Rate for Payer: Blue Shield of California EPN |
$466.44
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$479.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$479.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$776.85
|
| Rate for Payer: Heritage Provider Network Senior |
$776.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$479.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$598.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$643.12
|
| Rate for Payer: Multiplan Commercial |
$941.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$527.93
|
| Rate for Payer: TriValley Medical Group Senior |
$479.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$627.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$627.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$719.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.93
|
| Rate for Payer: Vantage Medical Group Senior |
$479.94
|
|
|
HC PROVOCHOLINE CHALLENGE
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
900801006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$227.16 |
| Max. Negotiated Rate |
$941.25 |
| Rate for Payer: Adventist Health Commercial |
$251.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$808.22
|
| Rate for Payer: Cash Price |
$564.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$849.63
|
| Rate for Payer: Heritage Provider Network Senior |
$849.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.75
|
| Rate for Payer: Multiplan Commercial |
$941.25
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SEP TRGT LESION
|
Facility
|
OP
|
$8,229.00
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
906811502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,645.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,085.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,994.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,525.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,116.15
|
| 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 |
$3,703.05
|
| Rate for Payer: Cash Price |
$3,703.05
|
| Rate for Payer: Cash Price |
$3,703.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,348.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,994.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,994.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,994.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,093.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,093.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,925.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,489.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,057.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,760.30
|
| Rate for Payer: Multiplan Commercial |
$6,171.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,994.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,994.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,994.65
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SEP TRGT LESION
|
Facility
|
IP
|
$8,229.00
|
|
|
Service Code
|
CPT 0914T
|
| Hospital Charge Code |
906811502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,489.45 |
| Max. Negotiated Rate |
$6,171.75 |
| Rate for Payer: Adventist Health Commercial |
$1,645.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,299.48
|
| Rate for Payer: Cash Price |
$3,703.05
|
| Rate for Payer: Cash Price |
$3,703.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,489.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,057.25
|
| Rate for Payer: Multiplan Commercial |
$6,171.75
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SINGLE ARTERY OR BRANCH
|
Facility
|
IP
|
$16,457.00
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
906811501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,978.72 |
| Max. Negotiated Rate |
$12,342.75 |
| Rate for Payer: Adventist Health Commercial |
$3,291.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,598.31
|
| Rate for Payer: Cash Price |
$7,405.65
|
| Rate for Payer: Cash Price |
$7,405.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,978.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.25
|
| Rate for Payer: Multiplan Commercial |
$12,342.75
|
|
|
HC PRQ TCAT THER RX NTRAC BLLN SINGLE ARTERY OR BRANCH
|
Facility
|
OP
|
$16,457.00
|
|
|
Service Code
|
CPT 0913T
|
| Hospital Charge Code |
906811501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$28,210.74 |
| Rate for Payer: Adventist Health Commercial |
$3,291.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,170.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,231.79
|
| 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 |
$7,405.65
|
| Rate for Payer: Cash Price |
$7,405.65
|
| Rate for Payer: Cash Price |
$7,405.65
|
| Rate for Payer: Cash Price |
$7,405.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,697.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,847.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,186.88
|
| Rate for Payer: Heritage Provider Network Senior |
$18,262.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$28,210.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,978.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,074.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$12,342.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16,332.54
|
| Rate for Payer: TriValley Medical Group Senior |
$14,847.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC PSEUDOANEURYSM INJECT TRT
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
909081388
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC PTA FEM/POP
|
Facility
|
OP
|
$12,237.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,214.90 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,447.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,562.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,401.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,730.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,177.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$5,506.65
|
| Rate for Payer: Cash Price |
$5,506.65
|
| Rate for Payer: Cash Price |
$5,506.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,954.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,401.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,401.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,401.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,574.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,574.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,837.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,214.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,059.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,565.90
|
| Rate for Payer: Multiplan Commercial |
$9,177.75
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| 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 |
$10,401.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,401.45
|
| Rate for Payer: Vantage Medical Group Senior |
$10,401.45
|
|
|
HC PTA FEM/POP
|
Facility
|
IP
|
$12,237.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
909020065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,214.90 |
| Max. Negotiated Rate |
$9,177.75 |
| Rate for Payer: Adventist Health Commercial |
$2,447.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,880.63
|
| Rate for Payer: Cash Price |
$5,506.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,284.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8,284.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,214.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,059.25
|
| Rate for Payer: Multiplan Commercial |
$9,177.75
|
|
|
HC PTA ILIAC
|
Facility
|
OP
|
$13,126.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
909020061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,375.81 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,625.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,111.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,157.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,219.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,844.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$5,906.70
|
| Rate for Payer: Cash Price |
$5,906.70
|
| Rate for Payer: Cash Price |
$5,906.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,531.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,157.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,157.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,157.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,124.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,124.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,261.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,375.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,281.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,188.20
|
| Rate for Payer: Multiplan Commercial |
$9,844.50
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| 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 |
$11,157.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,157.10
|
| Rate for Payer: Vantage Medical Group Senior |
$11,157.10
|
|
|
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: Aetna of CA Non-Gatekeeper |
$8,453.14
|
| Rate for Payer: Cash Price |
$5,906.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,886.30
|
| Rate for Payer: Heritage Provider Network Senior |
$8,886.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADDL
|
Facility
|
OP
|
$11,977.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
909020063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.84 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,401.79
|
| 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 |
$5,158.00
|
| 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 |
$5,389.65
|
| Rate for Payer: Cash Price |
$5,389.65
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$5,713.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$7,713.19
|
| Rate for Payer: Cash Price |
$5,389.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,108.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,108.43
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$8,962.13 |
| Rate for Payer: Cash Price |
$4,280.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,182.80
|
| Rate for Payer: Adventist Health Commercial |
$1,902.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,878.42
|
| 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 |
$5,158.00
|
| 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 |
$4,280.40
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4,537.22
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$6,125.73
|
| Rate for Payer: Cash Price |
$4,280.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,439.62
|
| Rate for Payer: Heritage Provider Network Senior |
$6,439.62
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$7,044.72
|
| Rate for Payer: Cash Price |
$4,922.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,405.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,405.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$9,298.15 |
| Rate for Payer: Adventist Health Commercial |
$2,187.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,760.30
|
| 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 |
$5,158.00
|
| 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 |
$4,922.55
|
| Rate for Payer: Cash Price |
$4,922.55
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$5,217.90
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 Non-Gatekeeper |
$15,125.55
|
| 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 |
$8,435.00
|
| 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 |
$11,013.75
|
| Rate for Payer: Cash Price |
$11,013.75
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$11,674.58
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$15,761.90
|
| Rate for Payer: Cash Price |
$11,013.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,569.58
|
| Rate for Payer: Heritage Provider Network Senior |
$16,569.58
|
| Rate for Payer: Kaiser Foundation Hospitals 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 TIBIOPERONEAL
|
Facility
|
OP
|
$11,602.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
909020069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,099.96 |
| Max. Negotiated Rate |
$22,958.69 |
| Rate for Payer: Adventist Health Commercial |
$2,320.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,170.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,861.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,381.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,701.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| 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 |
$5,220.90
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,541.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,861.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,861.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,861.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,181.64
|
| Rate for Payer: Heritage Provider Network Senior |
$7,181.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,534.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,099.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,900.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,121.40
|
| Rate for Payer: Multiplan Commercial |
$8,701.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| 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 |
$9,861.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,861.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,861.70
|
|
|
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: Aetna of CA Non-Gatekeeper |
$7,471.69
|
| Rate for Payer: Cash Price |
$5,220.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,854.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7,854.55
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$2,167.84 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$2,395.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,401.79
|
| 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 |
$5,158.00
|
| 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 |
$5,389.65
|
| Rate for Payer: Cash Price |
$5,389.65
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$5,713.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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: Aetna of CA Non-Gatekeeper |
$7,713.19
|
| Rate for Payer: Cash Price |
$5,389.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,108.43
|
| Rate for Payer: Heritage Provider Network Senior |
$8,108.43
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
|
