|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.02
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VAD ABIOMED IMPELLA CP CATH
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
906812480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$31,875.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,762.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,125.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,075.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,875.00
|
| Rate for Payer: Dignity Health Senior |
$31,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,362.50
|
| Rate for Payer: Heritage Provider Network Senior |
$17,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,250.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,548.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,416.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$31,875.00
|
|
|
HC VAD ABIOMED IMPELLA CP CATH
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
906812480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$28,125.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,075.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,075.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,362.50
|
| Rate for Payer: Heritage Provider Network Senior |
$17,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,750.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,375.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,548.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,416.25
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$222.63 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.71
|
| Rate for Payer: Heritage Provider Network Senior |
$832.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$799.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$761.37
|
| Rate for Payer: Heritage Provider Network Senior |
$518.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$800.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$463.60
|
| Rate for Payer: TriValley Medical Group Senior |
$463.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$799.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.71
|
| Rate for Payer: Heritage Provider Network Senior |
$832.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$442.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$407.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.63 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.71
|
| Rate for Payer: Heritage Provider Network Senior |
$832.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
OP
|
$3,724.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,990.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,558.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,165.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,048.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,793.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,271.64
|
| Rate for Payer: Blue Shield of California EPN |
$1,817.31
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,420.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,165.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,165.40
|
| Rate for Payer: Dignity Health Senior |
$3,165.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,305.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,305.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,387.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,776.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,606.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,606.80
|
| Rate for Payer: Multiplan Commercial |
$2,793.00
|
| 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 |
$3,165.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,165.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,165.40
|
|
|
HC VAG DEL PLUS ANTE/POST PARTUM
|
Facility
|
IP
|
$3,724.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
902400310
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$674.04 |
| Max. Negotiated Rate |
$2,793.00 |
| Rate for Payer: Adventist Health Commercial |
$744.80
|
| Rate for Payer: Cash Price |
$2,048.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,521.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,521.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.00
|
| Rate for Payer: Multiplan Commercial |
$2,793.00
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,016.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,819.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,477.00
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,560.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,749.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4,749.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,346.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,754.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,524.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,323.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
900501171
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,269.90 |
| Max. Negotiated Rate |
$5,262.00 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,749.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4,749.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,754.00
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.66
|
| Rate for Payer: Blue Shield of California Commercial |
$109.04
|
| Rate for Payer: Blue Shield of California EPN |
$87.46
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.89
|
| Rate for Payer: Dignity Health Senior |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.06
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Senior |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.89
|
| Rate for Payer: Vantage Medical Group Senior |
$13.54
|
|
|
HC VALPROIC ACID (DEPAKENE)
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
900910927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,291.49 |
| Max. Negotiated Rate |
$13,638.75 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| 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 |
$3,291.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,546.25
|
| Rate for Payer: Multiplan Commercial |
$13,638.75
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
IP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,797.72 |
| Max. Negotiated Rate |
$11,592.75 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cash Price |
$8,501.35
|
| 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 |
$2,797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,864.25
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$18,185.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906820030
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,564.73 |
| Max. Negotiated Rate |
$14,574.13 |
| Rate for Payer: Adventist Health Commercial |
$3,637.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,493.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cash Price |
$10,001.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,256.51
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,564.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,291.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,546.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$13,638.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, AORTIC
|
Facility
|
OP
|
$15,457.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
906811113
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,564.73 |
| Max. Negotiated Rate |
$14,574.13 |
| Rate for Payer: Adventist Health Commercial |
$3,091.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,618.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cash Price |
$8,501.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,567.88
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,564.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,797.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,864.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$11,592.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,244.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,865.20 |
| Max. Negotiated Rate |
$7,728.75 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cash Price |
$5,667.75
|
| 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 |
$1,865.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$338.21 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,328.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,504.14
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,030.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$9,092.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
OP
|
$10,305.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906811138
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$338.21 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,061.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,079.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cash Price |
$5,667.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,378.80
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$7,728.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, MITRAL
|
Facility
|
IP
|
$12,123.00
|
|
|
Service Code
|
CPT 92987
|
| Hospital Charge Code |
906820033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,194.26 |
| Max. Negotiated Rate |
$9,092.25 |
| Rate for Payer: Adventist Health Commercial |
$2,424.60
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Cash Price |
$6,667.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,030.75
|
| Rate for Payer: Multiplan Commercial |
$9,092.25
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,326.81 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,825.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,051.03
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,326.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,061.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,425.58 |
| Max. Negotiated Rate |
$10,050.75 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| 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 |
$2,425.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,350.25
|
| Rate for Payer: Multiplan Commercial |
$10,050.75
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
IP
|
$11,391.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906811137
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,061.77 |
| Max. Negotiated Rate |
$8,543.25 |
| Rate for Payer: Adventist Health Commercial |
$2,278.20
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Cash Price |
$6,265.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,061.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.75
|
| Rate for Payer: Multiplan Commercial |
$8,543.25
|
|
|
HC VALVULOPLASTY, PULMONARY
|
Facility
|
OP
|
$13,401.00
|
|
|
Service Code
|
CPT 92990
|
| Hospital Charge Code |
906820032
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,326.81 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$2,680.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,206.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cash Price |
$7,370.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,295.22
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,326.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,425.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,350.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$10,050.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
