|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018422
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018422
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 Senior |
$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 Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$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 MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018222
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9186
|
| Hospital Charge Code |
900018122
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
|
OP
|
$6,824.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,800.40 |
| Rate for Payer: Adventist Health Commercial |
$1,364.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,688.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,753.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,118.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cash Price |
$3,070.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,800.40
|
| Rate for Payer: Dignity Health Senior |
$5,800.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$537.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,255.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,235.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,706.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,776.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,776.80
|
| Rate for Payer: Multiplan Commercial |
$5,118.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,800.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,800.40
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
OP
|
$6,406.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,445.10 |
| Rate for Payer: Adventist Health Commercial |
$1,281.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,400.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,523.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,804.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cash Price |
$2,882.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,445.10
|
| Rate for Payer: Dignity Health Senior |
$5,445.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,055.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,159.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,484.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,484.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,445.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,445.10
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$792.24 |
| Max. Negotiated Rate |
$3,282.75 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,963.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,963.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.25
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
OP
|
$5,952.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Adventist Health Commercial |
$1,190.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,089.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,273.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,464.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cash Price |
$2,678.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,059.20
|
| Rate for Payer: Dignity Health Senior |
$5,059.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,839.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,077.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,488.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,166.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,166.40
|
| Rate for Payer: Multiplan Commercial |
$4,464.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,059.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,059.20
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$594.22 |
| Max. Negotiated Rate |
$2,462.25 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,222.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,222.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$820.75
|
| Rate for Payer: Multiplan Commercial |
$2,462.25
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
OP
|
$5,356.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,552.60 |
| Rate for Payer: Adventist Health Commercial |
$1,071.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,862.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,679.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,945.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,017.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cash Price |
$2,410.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,552.60
|
| Rate for Payer: Dignity Health Senior |
$4,552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,554.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$969.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,749.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,749.20
|
| Rate for Payer: Multiplan Commercial |
$4,017.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,552.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,552.60
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
|
IP
|
$5,697.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,272.75 |
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,856.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,856.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
IP
|
$5,697.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,272.75 |
| Rate for Payer: Adventist Health Commercial |
$1,139.40
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: Cash Price |
$2,563.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,856.87
|
| Rate for Payer: Heritage Provider Network Senior |
$3,856.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.25
|
| Rate for Payer: Multiplan Commercial |
$4,272.75
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
|
OP
|
$4,898.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,163.30 |
| Rate for Payer: Adventist Health Commercial |
$979.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,617.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,364.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,693.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,673.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cash Price |
$2,204.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,163.30
|
| Rate for Payer: Dignity Health Senior |
$4,163.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,336.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,224.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,428.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,428.60
|
| Rate for Payer: Multiplan Commercial |
$3,673.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,163.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.30
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,189.20 |
| Rate for Payer: Adventist Health Commercial |
$750.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,577.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,063.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,814.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cash Price |
$1,688.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,189.20
|
| Rate for Payer: Dignity Health Senior |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,789.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$938.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,626.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,626.40
|
| Rate for Payer: Multiplan Commercial |
$2,814.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,189.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,189.20
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
|
IP
|
$5,590.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,192.50 |
| Rate for Payer: Adventist Health Commercial |
$1,118.00
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: Cash Price |
$2,515.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,784.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,784.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,011.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,397.50
|
| Rate for Payer: Multiplan Commercial |
$4,192.50
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
OP
|
$3,298.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,803.30 |
| Rate for Payer: Adventist Health Commercial |
$659.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,265.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,813.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,473.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,803.30
|
| Rate for Payer: Dignity Health Senior |
$2,803.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,573.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$824.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,308.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,308.60
|
| Rate for Payer: Multiplan Commercial |
$2,473.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,803.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,803.30
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$840.20 |
| Max. Negotiated Rate |
$3,481.50 |
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,142.63
|
| Rate for Payer: Heritage Provider Network Senior |
$3,142.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.50
|
| Rate for Payer: Multiplan Commercial |
$3,481.50
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,892.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Senior |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,008.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$6,426.00 |
| Rate for Payer: Adventist Health Commercial |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: Cash Price |
$3,855.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,800.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5,800.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,550.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,142.00
|
| Rate for Payer: Multiplan Commercial |
$6,426.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
IP
|
$5,870.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,402.50 |
| Rate for Payer: Adventist Health Commercial |
$1,174.00
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: Cash Price |
$2,641.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,973.99
|
| Rate for Payer: Heritage Provider Network Senior |
$3,973.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,062.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,467.50
|
| Rate for Payer: Multiplan Commercial |
$4,402.50
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,579.35 |
| Rate for Payer: Adventist Health Commercial |
$842.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,892.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,316.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,158.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,894.37
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cash Price |
$1,894.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,579.35
|
| Rate for Payer: Dignity Health Senior |
$3,579.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,008.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$762.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,947.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,947.70
|
| Rate for Payer: Multiplan Commercial |
$3,158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,579.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3,579.35
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
|
IP
|
$3,372.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$610.33 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$674.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,282.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,282.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.00
|
| Rate for Payer: Multiplan Commercial |
$2,529.00
|
|
