|
HC CARDIAC STRESS TEST
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
906811397
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$277.71 |
| Max. Negotiated Rate |
$2,410.50 |
| Rate for Payer: Adventist Health Commercial |
$642.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,986.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,607.64
|
| Rate for Payer: Blue Shield of California Commercial |
$357.26
|
| Rate for Payer: Blue Shield of California EPN |
$287.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,089.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,896.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,989.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,989.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,533.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$581.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$2,410.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$305.48
|
| Rate for Payer: TriValley Medical Group Senior |
$277.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$992.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$834.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC CARDIOLIPIN AB EAC IG CLASS
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.32
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.62
|
| Rate for Payer: Heritage Provider Network Senior |
$149.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
|
|
HC CARDIOLIPIN AB EAC IG CLASS
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913559
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$147.97 |
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$143.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$136.80
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$105.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$385.71 |
| Max. Negotiated Rate |
$1,598.25 |
| Rate for Payer: Adventist Health Commercial |
$426.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,372.36
|
| Rate for Payer: Cash Price |
$958.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,442.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,442.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.75
|
| Rate for Payer: Multiplan Commercial |
$1,598.25
|
|
|
HC CARDIOLITE PERFUSION SCAN
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
909301560
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$385.71 |
| Max. Negotiated Rate |
$2,497.70 |
| Rate for Payer: Adventist Health Commercial |
$426.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,065.93
|
| Rate for Payer: Blue Shield of California Commercial |
$870.00
|
| Rate for Payer: Blue Shield of California EPN |
$699.62
|
| Rate for Payer: Cash Price |
$958.95
|
| Rate for Payer: Cash Price |
$958.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,385.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,385.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,665.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,319.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,319.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,016.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$1,598.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,831.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1,665.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,065.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,065.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$612.87 |
| Max. Negotiated Rate |
$2,539.50 |
| Rate for Payer: Adventist Health Commercial |
$677.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,092.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,693.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,682.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,352.62
|
| Rate for Payer: Cash Price |
$1,523.70
|
| Rate for Payer: Cash Price |
$1,523.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,200.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,200.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,665.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,095.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,095.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,615.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$2,539.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,831.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1,665.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,693.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,693.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC CARDIOLITE PERFUSION SCAN 1 DY
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
909301562
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$612.87 |
| Max. Negotiated Rate |
$2,539.50 |
| Rate for Payer: Adventist Health Commercial |
$677.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,180.58
|
| Rate for Payer: Cash Price |
$1,523.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,292.32
|
| Rate for Payer: Heritage Provider Network Senior |
$2,292.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$612.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$846.50
|
| Rate for Payer: Multiplan Commercial |
$2,539.50
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$461.01 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,640.27
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.75
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$461.01 |
| Max. Negotiated Rate |
$1,910.25 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,640.27
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,724.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,724.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.75
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$277.71 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,574.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,576.59
|
| Rate for Payer: Heritage Provider Network Senior |
$341.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$527.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$305.48
|
| Rate for Payer: TriValley Medical Group Senior |
$277.71
|
| 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 |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC CARDIOPULMONARY RESUSCITATION
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
906812198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.71 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,574.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,209.83
|
| Rate for Payer: Blue Shield of California EPN |
$962.77
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,655.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,655.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,724.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,724.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,214.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Multiplan WC |
$630.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,528.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.99 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,115.30
|
| Rate for Payer: Blue Shield of California EPN |
$887.54
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,526.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,589.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,589.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,120.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
| Rate for Payer: Multiplan WC |
$1,324.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,408.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,408.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$3,758.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$751.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,322.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,217.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,326.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,045.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,615.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$2,818.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$935.09
|
| Rate for Payer: TriValley Medical Group Senior |
$850.08
|
| 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 |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$3,758.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$680.20 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$751.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,420.15
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Cash Price |
$1,691.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$680.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.50
|
| Rate for Payer: Multiplan Commercial |
$2,818.50
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.58
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.99 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.11
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,589.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,589.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$424.99 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,512.11
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,045.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,615.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$935.09
|
| Rate for Payer: TriValley Medical Group Senior |
$850.08
|
| 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 |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$2,348.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$424.99 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$469.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cash Price |
$1,056.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,526.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,385.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,453.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,045.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,615.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$1,761.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$935.09
|
| Rate for Payer: TriValley Medical Group Senior |
$850.08
|
| 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 |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC CARRY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018406
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 CARRY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018406
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC CARRY CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018306
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 CARRY CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8984
|
| Hospital Charge Code |
900018306
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC CARRY D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8986
|
| Hospital Charge Code |
900018308
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| 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 |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 CARRY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8986
|
| Hospital Charge Code |
900018308
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
