|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
IP
|
$4,786.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.27 |
| Max. Negotiated Rate |
$3,589.50 |
| Rate for Payer: Adventist Health Commercial |
$957.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,287.98
|
| Rate for Payer: Cash Price |
$2,153.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,240.12
|
| Rate for Payer: Heritage Provider Network Senior |
$3,240.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.50
|
| Rate for Payer: Multiplan Commercial |
$3,589.50
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
OP
|
$3,191.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,712.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,755.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,393.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,074.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,712.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,712.35
|
| Rate for Payer: Dignity Health Senior |
$2,712.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,975.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,975.23
|
| Rate for Payer: IEHP Medi-Cal |
$91.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,538.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.75
|
| Rate for Payer: Multiplan Commercial |
$2,393.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,712.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,712.35
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
IP
|
$3,191.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.57 |
| Max. Negotiated Rate |
$2,393.25 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.22
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,160.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,160.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.75
|
| Rate for Payer: Multiplan Commercial |
$2,393.25
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
OP
|
$3,191.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.04 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,712.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,755.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,393.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,074.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,712.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,712.35
|
| Rate for Payer: Dignity Health Senior |
$2,712.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,914.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,975.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,975.23
|
| Rate for Payer: IEHP Medi-Cal |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,538.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.75
|
| Rate for Payer: Multiplan Commercial |
$2,393.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,712.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,712.35
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
IP
|
$3,191.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$577.57 |
| Max. Negotiated Rate |
$2,393.25 |
| Rate for Payer: Adventist Health Commercial |
$638.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,192.22
|
| Rate for Payer: Cash Price |
$1,435.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,160.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,160.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.75
|
| Rate for Payer: Multiplan Commercial |
$2,393.25
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
IP
|
$7,882.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,426.64 |
| Max. Negotiated Rate |
$5,911.50 |
| Rate for Payer: Adventist Health Commercial |
$1,576.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,414.93
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,336.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,336.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.50
|
| Rate for Payer: Multiplan Commercial |
$5,911.50
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
OP
|
$7,882.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.03 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,576.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,414.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,123.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,729.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,878.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$311.03
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$5,911.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
OP
|
$7,882.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.73 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,576.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,414.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,123.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,729.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,878.96
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: IEHP Medi-Cal |
$304.73
|
| Rate for Payer: IEHP Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$5,911.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
IP
|
$7,882.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,426.64 |
| Max. Negotiated Rate |
$5,911.50 |
| Rate for Payer: Adventist Health Commercial |
$1,576.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,414.93
|
| Rate for Payer: Cash Price |
$3,546.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,336.11
|
| Rate for Payer: Heritage Provider Network Senior |
$5,336.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,970.50
|
| Rate for Payer: Multiplan Commercial |
$5,911.50
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
OP
|
$25,089.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,541.11 |
| Max. Negotiated Rate |
$21,325.65 |
| Rate for Payer: Adventist Health Commercial |
$5,017.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,236.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21,325.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,798.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18,816.75
|
| 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 |
$11,290.05
|
| Rate for Payer: Cash Price |
$11,290.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,307.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,325.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,325.65
|
| Rate for Payer: Dignity Health Senior |
$21,325.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,053.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$15,530.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,092.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,541.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,272.25
|
| Rate for Payer: Multiplan Commercial |
$18,816.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,325.65
|
| Rate for Payer: Vantage Medical Group Senior |
$21,325.65
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
IP
|
$25,089.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,541.11 |
| Max. Negotiated Rate |
$18,816.75 |
| Rate for Payer: Adventist Health Commercial |
$5,017.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,236.14
|
| Rate for Payer: Cash Price |
$11,290.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,985.25
|
| Rate for Payer: Heritage Provider Network Senior |
$16,985.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,541.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,272.25
|
| Rate for Payer: Multiplan Commercial |
$18,816.75
|
|
|
HC RH BLOOD GROUP
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$95.21 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.74
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: IEHP Medi-Cal |
$3.84
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC RH BLOOD GROUP
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
IP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906820062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,390.70 |
| Max. Negotiated Rate |
$18,193.50 |
| Rate for Payer: Adventist Health Commercial |
$4,851.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,665.25
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,390.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,064.50
|
| Rate for Payer: Multiplan Commercial |
$18,193.50
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
OP
|
$24,258.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906820062
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,742.11 |
| Max. Negotiated Rate |
$18,193.50 |
| Rate for Payer: Adventist Health Commercial |
$4,851.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,665.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cash Price |
$10,916.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,767.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,015.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,742.11
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,390.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,064.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$18,193.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
IP
|
$16,895.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,058.00 |
| Max. Negotiated Rate |
$12,671.25 |
| Rate for Payer: Adventist Health Commercial |
$3,379.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,606.86
|
| Rate for Payer: Cash Price |
$7,602.75
|
| Rate for Payer: Cash Price |
$7,602.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,058.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,223.75
|
| Rate for Payer: Multiplan Commercial |
$12,671.25
|
|
|
HC RHC,CORO CATH,CORO ANG,GRFT,IM
|
Facility
OP
|
$16,895.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
906811404
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,742.11 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$3,379.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,606.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,602.75
|
| Rate for Payer: Cash Price |
$7,602.75
|
| Rate for Payer: Cash Price |
$7,602.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,981.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,458.00
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,742.11
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,058.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,223.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$12,671.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
OP
|
$23,291.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906820061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,536.62 |
| Max. Negotiated Rate |
$17,468.25 |
| Rate for Payer: Adventist Health Commercial |
$4,658.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,000.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,139.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,417.13
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,536.62
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,215.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,822.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$17,468.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
IP
|
$23,291.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906820061
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,215.67 |
| Max. Negotiated Rate |
$17,468.25 |
| Rate for Payer: Adventist Health Commercial |
$4,658.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,000.92
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Cash Price |
$10,480.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,215.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,822.75
|
| Rate for Payer: Multiplan Commercial |
$17,468.25
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
OP
|
$16,220.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,536.62 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$3,244.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,143.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,543.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,040.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,536.62
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,055.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$12,165.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC, CORO CATH, CORO ANGIO
|
Facility
IP
|
$16,220.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
906811403
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,935.82 |
| Max. Negotiated Rate |
$12,165.00 |
| Rate for Payer: Adventist Health Commercial |
$3,244.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,143.14
|
| Rate for Payer: Cash Price |
$7,299.00
|
| Rate for Payer: Cash Price |
$7,299.00
|
| 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 |
$2,935.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,055.00
|
| Rate for Payer: Multiplan Commercial |
$12,165.00
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
OP
|
$25,199.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906820065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,747.65 |
| Max. Negotiated Rate |
$18,899.25 |
| Rate for Payer: Adventist Health Commercial |
$5,039.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,311.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,379.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,598.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,747.65
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,561.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,299.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$18,899.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
IP
|
$25,199.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906820065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,561.02 |
| Max. Negotiated Rate |
$18,899.25 |
| Rate for Payer: Adventist Health Commercial |
$5,039.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,311.71
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Cash Price |
$11,339.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,561.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,299.75
|
| Rate for Payer: Multiplan Commercial |
$18,899.25
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
OP
|
$14,040.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,747.65 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$2,808.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,645.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$6,318.00
|
| Rate for Payer: Cash Price |
$6,318.00
|
| Rate for Payer: Cash Price |
$6,318.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,126.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,690.76
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,747.65
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,541.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,510.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$10,530.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC,CORONARY ANG,W/WO LV
|
Facility
IP
|
$14,040.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
906811407
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,541.24 |
| Max. Negotiated Rate |
$10,530.00 |
| Rate for Payer: Adventist Health Commercial |
$2,808.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,645.48
|
| Rate for Payer: Cash Price |
$6,318.00
|
| Rate for Payer: Cash Price |
$6,318.00
|
| 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 |
$2,541.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,510.00
|
| Rate for Payer: Multiplan Commercial |
$10,530.00
|
|
