|
HC CONG RT AND LT HEAR CATH ABNL NAT
|
Facility
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93597
|
| Hospital Charge Code |
906820094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,273.15 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,832.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,572.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,354.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$5,275.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,478.50
|
| Rate for Payer: TriValley Medical Group Senior |
$4,071.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,273.15 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,832.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,572.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,354.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$5,275.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,478.50
|
| Rate for Payer: TriValley Medical Group Senior |
$4,071.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT AND LT HEART CATH NML NAT
|
Facility
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93596
|
| Hospital Charge Code |
906820093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,273.15 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,832.36
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| 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 |
$1,273.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.50
|
| Rate for Payer: Multiplan Commercial |
$5,275.50
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
OP
|
$7,034.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,273.15 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,832.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,572.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,354.05
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$5,275.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,478.50
|
| Rate for Payer: TriValley Medical Group Senior |
$4,071.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC CONG RT HEART CONG NML NAT
|
Facility
IP
|
$7,034.00
|
|
|
Service Code
|
CPT 93593
|
| Hospital Charge Code |
906820095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,273.15 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,406.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,832.36
|
| Rate for Payer: Cash Price |
$3,165.30
|
| Rate for Payer: Cash Price |
$3,165.30
|
| 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 |
$1,273.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,758.50
|
| Rate for Payer: Multiplan Commercial |
$5,275.50
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
OP
|
$378.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$96.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| 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 |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$245.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.98
|
| Rate for Payer: Heritage Provider Network Senior |
$233.98
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$26.52
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC CONT INHAL TRT W/AERO 1ST HR
|
Facility
IP
|
$378.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
900800012
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$259.69
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$255.91
|
| Rate for Payer: Heritage Provider Network Senior |
$255.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
OP
|
$282.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$211.50
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Senior |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.56
|
| Rate for Payer: Heritage Provider Network Senior |
$174.56
|
| Rate for Payer: IEHP Medi-Cal |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$135.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC CONT INHAL TRT W/AERO ADD HR
|
Facility
IP
|
$282.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
900800013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.73
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.91
|
| Rate for Payer: Heritage Provider Network Senior |
$190.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC CONT OROPHARYN HEMOR, SIMPLE
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
900501252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.00
|
| 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 |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| 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 |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CONTRAST BATH 15MIN OT
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905104124
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.25
|
| 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 |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.15
|
| Rate for Payer: Dignity Health Senior |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.04
|
| Rate for Payer: Heritage Provider Network Senior |
$86.04
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| 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 |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.10
|
| Rate for Payer: Heritage Provider Network Senior |
$94.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.10
|
| Rate for Payer: Heritage Provider Network Senior |
$94.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.25
|
| 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 |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.15
|
| Rate for Payer: Dignity Health Senior |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.04
|
| Rate for Payer: Heritage Provider Network Senior |
$86.04
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| 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 |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.25
|
| 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 |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.15
|
| Rate for Payer: Dignity Health Senior |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.04
|
| Rate for Payer: Heritage Provider Network Senior |
$86.04
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| 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 |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.10
|
| Rate for Payer: Heritage Provider Network Senior |
$94.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$104.25
|
| 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 |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$90.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$118.15
|
| Rate for Payer: Dignity Health Senior |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.04
|
| Rate for Payer: Heritage Provider Network Senior |
$86.04
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| 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 |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$26.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.00
|
| 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 |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.20
|
| Rate for Payer: Dignity Health Senior |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: IEHP Medi-Cal |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| 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 |
$44.20
|
| Rate for Payer: Vantage Medical Group Senior |
$44.20
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Adventist Health Commercial |
$27.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$95.49
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.10
|
| Rate for Payer: Heritage Provider Network Senior |
$94.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.75
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
|
|
HC COOMBS TEST DIRECT
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.75
|
| Rate for Payer: Heritage Provider Network Senior |
$167.75
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$7.47
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC COOMBS TEST DIRECT
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
