|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
947200111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$77.72
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
948100111
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC IV PUSH SINGLE OR INIT DRUG
|
Facility
OP
|
$555.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
907296374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$267.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$201.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
IP
|
$555.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.28
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
|
|
HC IV PUSH SINGLER OR INIT DRUG
|
Facility
OP
|
$555.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
910196374
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$132.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.54
|
| Rate for Payer: Heritage Provider Network Senior |
$343.54
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: IEHP Medi-Cal |
$77.72
|
| Rate for Payer: IEHP Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
OP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,510.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,186.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,417.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,152.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,662.50
|
| 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 |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,417.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,417.50
|
| Rate for Payer: Dignity Health Senior |
$6,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,907.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,673.45
|
| Rate for Payer: Heritage Provider Network Senior |
$4,673.45
|
| Rate for Payer: IEHP Medi-Cal |
$350.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,639.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,366.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.50
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,417.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,417.50
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
IP
|
$7,550.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906820080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,366.55 |
| Max. Negotiated Rate |
$5,662.50 |
| Rate for Payer: Adventist Health Commercial |
$1,510.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,186.85
|
| Rate for Payer: Cash Price |
$3,397.50
|
| Rate for Payer: Cash Price |
$3,397.50
|
| 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 |
$1,366.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,887.50
|
| Rate for Payer: Multiplan Commercial |
$5,662.50
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
OP
|
$4,169.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$833.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$202.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,543.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,292.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,126.75
|
| 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 |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,543.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,543.65
|
| Rate for Payer: Dignity Health Senior |
$3,543.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,709.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,580.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,580.61
|
| Rate for Payer: IEHP Medi-Cal |
$350.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,009.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.25
|
| Rate for Payer: Multiplan Commercial |
$3,126.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,543.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3,543.65
|
|
|
HC IVPW ADDL VES PRESSUREWIRE SEN
|
Facility
IP
|
$4,169.00
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
906812134
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.59 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$833.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.10
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.25
|
| Rate for Payer: Multiplan Commercial |
$3,126.75
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
IP
|
$7,357.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,331.62 |
| Max. Negotiated Rate |
$5,517.75 |
| Rate for Payer: Adventist Health Commercial |
$1,471.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,054.26
|
| Rate for Payer: Cash Price |
$3,310.65
|
| Rate for Payer: Cash Price |
$3,310.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.25
|
| Rate for Payer: Multiplan Commercial |
$5,517.75
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
OP
|
$7,357.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906812133
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.78 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,471.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$415.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,054.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,253.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,046.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,517.75
|
| 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 |
$3,310.65
|
| Rate for Payer: Cash Price |
$3,310.65
|
| Rate for Payer: Cash Price |
$3,310.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,253.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,253.45
|
| Rate for Payer: Dignity Health Senior |
$6,253.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,782.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,553.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,553.98
|
| Rate for Payer: IEHP Medi-Cal |
$378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,546.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.25
|
| Rate for Payer: Multiplan Commercial |
$5,517.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,253.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,253.45
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
OP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$378.78 |
| Max. Negotiated Rate |
$11,058.50 |
| Rate for Payer: Adventist Health Commercial |
$2,602.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$415.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,937.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,058.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,155.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,757.50
|
| 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 |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,058.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,058.50
|
| Rate for Payer: Dignity Health Senior |
$11,058.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,456.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,053.19
|
| Rate for Payer: Heritage Provider Network Senior |
$8,053.19
|
| Rate for Payer: IEHP Medi-Cal |
$378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,270.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,354.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,252.50
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,058.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,058.50
|
|
|
HC IVPW INIT VES PRESSUREWIRE SEN
|
Facility
IP
|
$13,010.00
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
906820079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,354.81 |
| Max. Negotiated Rate |
$9,757.50 |
| Rate for Payer: Adventist Health Commercial |
$2,602.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,937.87
|
| Rate for Payer: Cash Price |
$5,854.50
|
| Rate for Payer: Cash Price |
$5,854.50
|
| 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 |
$2,354.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,252.50
|
| Rate for Payer: Multiplan Commercial |
$9,757.50
|
|
|
HC IVU EXCRETORY
|
Facility
IP
|
$1,549.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.37 |
| Max. Negotiated Rate |
$1,161.75 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,064.16
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,048.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.25
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
|
|
HC IVU EXCRETORY
|
Facility
OP
|
$1,549.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
909001910
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$1,161.75 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,064.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.85
|
| Rate for Payer: Blue Shield of California Commercial |
$346.84
|
| Rate for Payer: Blue Shield of California EPN |
$197.24
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,006.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$958.83
|
| Rate for Payer: Heritage Provider Network Senior |
$958.83
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$102.55
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC IVU HYPERTENSIVE
|
Facility
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Adventist Health Commercial |
$277.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$250.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$952.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.62
|
| Rate for Payer: Blue Shield of California Commercial |
$432.59
|
| Rate for Payer: Blue Shield of California EPN |
$246.00
|
| Rate for Payer: Cash Price |
$624.15
|
| Rate for Payer: Cash Price |
$624.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$901.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$901.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$858.55
|
| Rate for Payer: Heritage Provider Network Senior |
$858.55
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$154.94
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$1,040.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC IVU HYPERTENSIVE
|
Facility
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74415
|
| Hospital Charge Code |
909001911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.05 |
| Max. Negotiated Rate |
$1,040.25 |
| Rate for Payer: Adventist Health Commercial |
$277.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$952.87
|
| Rate for Payer: Cash Price |
$624.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$939.00
|
| Rate for Payer: Heritage Provider Network Senior |
$939.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.75
|
| Rate for Payer: Multiplan Commercial |
$1,040.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
IP
|
$4,169.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.59 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$833.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.10
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.25
|
| Rate for Payer: Multiplan Commercial |
$3,126.75
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
IP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,510.44 |
| Max. Negotiated Rate |
$6,258.75 |
| Rate for Payer: Adventist Health Commercial |
$1,669.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,733.02
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| 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 |
$1,510.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,086.25
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
OP
|
$8,345.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906820035
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$214.95 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,669.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,733.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,093.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,589.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,258.75
|
| 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 |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Cash Price |
$3,755.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,093.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,093.25
|
| Rate for Payer: Dignity Health Senior |
$7,093.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,424.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,165.56
|
| Rate for Payer: Heritage Provider Network Senior |
$5,165.56
|
| Rate for Payer: IEHP Medi-Cal |
$214.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,022.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,510.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,086.25
|
| Rate for Payer: Multiplan Commercial |
$6,258.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,093.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7,093.25
|
|
|
HC IVUS ADD'L VESSEL
|
Facility
OP
|
$4,169.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
906811210
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$214.95 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$833.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,864.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,543.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,292.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,126.75
|
| 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 |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cash Price |
$1,876.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,543.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,543.65
|
| Rate for Payer: Dignity Health Senior |
$3,543.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,709.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,580.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,580.61
|
| Rate for Payer: IEHP Medi-Cal |
$214.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,009.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.25
|
| Rate for Payer: Multiplan Commercial |
$3,126.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,543.65
|
| Rate for Payer: Vantage Medical Group Senior |
$3,543.65
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
OP
|
$7,369.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$351.30 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,473.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,062.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,263.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,052.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,526.75
|
| 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 |
$3,316.05
|
| Rate for Payer: Cash Price |
$3,316.05
|
| Rate for Payer: Cash Price |
$3,316.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,263.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,263.65
|
| Rate for Payer: Dignity Health Senior |
$6,263.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,789.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,561.41
|
| Rate for Payer: Heritage Provider Network Senior |
$4,561.41
|
| Rate for Payer: IEHP Medi-Cal |
$351.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,551.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.25
|
| Rate for Payer: Multiplan Commercial |
$5,526.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,263.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,263.65
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
OP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$351.30 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,346.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,058.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,970.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,451.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,797.50
|
| 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 |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,970.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,970.50
|
| Rate for Payer: Dignity Health Senior |
$9,970.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,624.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,260.87
|
| Rate for Payer: Heritage Provider Network Senior |
$7,260.87
|
| Rate for Payer: IEHP Medi-Cal |
$351.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,653.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,123.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,932.50
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,970.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,970.50
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
IP
|
$11,730.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906820034
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,123.13 |
| Max. Negotiated Rate |
$8,797.50 |
| Rate for Payer: Adventist Health Commercial |
$2,346.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,058.51
|
| Rate for Payer: Cash Price |
$5,278.50
|
| Rate for Payer: Cash Price |
$5,278.50
|
| 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 |
$2,123.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,932.50
|
| Rate for Payer: Multiplan Commercial |
$8,797.50
|
|
|
HC IVUS INITIAL VESSEL
|
Facility
IP
|
$7,369.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
906811200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,333.79 |
| Max. Negotiated Rate |
$5,526.75 |
| Rate for Payer: Adventist Health Commercial |
$1,473.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,062.50
|
| Rate for Payer: Cash Price |
$3,316.05
|
| Rate for Payer: Cash Price |
$3,316.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,842.25
|
| Rate for Payer: Multiplan Commercial |
$5,526.75
|
|
