|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$4,170.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906820082
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$834.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| 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 |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cash Price |
$1,876.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,581.23
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$3,127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| 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 Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$630.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,164.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| 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 |
$1,417.50
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,949.85
|
| Rate for Payer: Heritage Provider Network Senior |
$482.37
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$745.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$2,362.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$431.39
|
| Rate for Payer: TriValley Medical Group Senior |
$392.17
|
| 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 Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$570.15 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$630.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,164.05
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cash Price |
$1,417.50
|
| 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 |
$570.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$2,362.50
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.28 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$630.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,164.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,047.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,132.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,132.55
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,518.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$2,362.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,143.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,052.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$3,150.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.15 |
| Max. Negotiated Rate |
$2,362.50 |
| Rate for Payer: Adventist Health Commercial |
$630.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,164.05
|
| Rate for Payer: Cash Price |
$1,417.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,132.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,132.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$570.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$2,362.50
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$294.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,477.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| 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 |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,397.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,330.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.19
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$894.48
|
| Rate for Payer: TriValley Medical Group Senior |
$813.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
906820027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,051.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$294.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| 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 |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,416.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,416.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,253.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.19
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$951.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$894.48
|
| Rate for Payer: TriValley Medical Group Senior |
$813.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$3,440.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$622.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,363.28
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| 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 |
$622.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.00
|
| Rate for Payer: Multiplan Commercial |
$2,580.00
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,477.05
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$3,440.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$294.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,363.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| 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 |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,236.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,236.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,129.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.19
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$860.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$2,580.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$894.48
|
| Rate for Payer: TriValley Medical Group Senior |
$813.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$294.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| 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 |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$285.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.19
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,545.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$894.48
|
| Rate for Payer: TriValley Medical Group Senior |
$813.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$92.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.71
|
| Rate for Payer: Cash Price |
$207.45
|
| Rate for Payer: Cash Price |
$207.45
|
| 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 |
$83.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.25
|
| Rate for Payer: Multiplan Commercial |
$345.75
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
906820027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$951.34 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,051.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,610.87
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| 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 |
$951.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.36 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$294.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,477.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,397.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: Dignity Health Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,397.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$813.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.55
|
| Rate for Payer: Humana Medicare |
$813.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,036.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,024.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,024.58
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$780.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$718.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,477.05
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| 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 |
$389.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Senior |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.57
|
| Rate for Payer: Heritage Provider Network Senior |
$44.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Senior |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.46
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.74
|
| Rate for Payer: Heritage Provider Network Senior |
$48.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: Dignity Health Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$553.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.39
|
| Rate for Payer: Heritage Provider Network Senior |
$501.39
|
| Rate for Payer: Humana Medicare |
$553.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,051.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.27
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: Dignity Health Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$553.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.16
|
| Rate for Payer: Heritage Provider Network Senior |
$461.16
|
| Rate for Payer: Humana Medicare |
$553.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,051.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.27
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$1,051.44 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: Dignity Health Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$553.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.39
|
| Rate for Payer: Heritage Provider Network Senior |
$501.39
|
| Rate for Payer: Humana Medicare |
$553.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,051.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.27
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.82
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.36
|
| Rate for Payer: Heritage Provider Network Senior |
$504.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
