|
HC MUMPS ANTIBODY
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$105.00
|
| Rate for Payer: Blue Shield of California EPN |
$84.22
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.05
|
| Rate for Payer: TriValley Medical Group Senior |
$13.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS ANTIBODY
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913663
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
IP
|
$1,996.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.28 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,351.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
|
|
HC MUSCLE BIOPSY, PERCUTANEOUS
|
Facility
|
OP
|
$1,996.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
909000105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$399.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,371.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cash Price |
$1,097.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,297.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.52
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$499.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,497.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$298.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Blue Shield of California Commercial |
$265.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.28
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$282.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Senior |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.26
|
| Rate for Payer: Heritage Provider Network Senior |
$269.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$207.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$522.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC MUSCLE TEST MANUAL W RPT
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900895831
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.73 |
| Max. Negotiated Rate |
$326.25 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$294.50
|
| Rate for Payer: Heritage Provider Network Senior |
$294.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
IP
|
$2,446.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$442.73 |
| Max. Negotiated Rate |
$1,834.50 |
| Rate for Payer: Adventist Health Commercial |
$489.20
|
| Rate for Payer: Cash Price |
$1,345.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,655.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,655.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.50
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
|
|
HC MYELOGRAM, CERVICAL
|
Facility
|
OP
|
$2,446.00
|
|
|
Service Code
|
CPT 72240
|
| Hospital Charge Code |
909001363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.83 |
| Max. Negotiated Rate |
$1,834.50 |
| Rate for Payer: Adventist Health Commercial |
$489.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,307.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,680.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.56
|
| Rate for Payer: Blue Shield of California Commercial |
$999.65
|
| Rate for Payer: Blue Shield of California EPN |
$803.88
|
| Rate for Payer: Cash Price |
$1,345.30
|
| Rate for Payer: Cash Price |
$1,345.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,589.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,514.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,514.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,166.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,003.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,296.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,296.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.93 |
| Max. Negotiated Rate |
$1,585.07 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,023.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,315.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,585.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cash Price |
$1,053.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,244.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,244.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,185.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,185.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$182.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$913.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,003.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.99 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,511.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,511.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$403.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$446.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,533.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cash Price |
$1,227.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,339.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,381.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,907.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$403.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,674.00
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,104.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
IP
|
$1,916.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$1,437.00 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Cash Price |
$1,053.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
|
OP
|
$1,916.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$383.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,053.80
|
| Rate for Payer: Cash Price |
$1,053.80
|
| Rate for Payer: Cash Price |
$1,053.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,245.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,149.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,907.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,437.00
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,104.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$2,715.75 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,451.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,451.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,487.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,353.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,241.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,907.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,104.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
IP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.40 |
| Max. Negotiated Rate |
$2,715.75 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,451.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,451.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
|
OP
|
$3,621.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$724.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,487.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cash Price |
$1,991.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,353.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,241.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,907.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$905.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$2,715.75
|
| Rate for Payer: Multiplan WC |
$1,599.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,104.23
|
| Rate for Payer: TriValley Medical Group Senior |
$1,104.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.81 |
| Max. Negotiated Rate |
$1,505.78 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$758.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.25
|
| Rate for Payer: Blue Shield of California Commercial |
$857.95
|
| Rate for Payer: Blue Shield of California EPN |
$689.94
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.98
|
| Rate for Payer: Heritage Provider Network Senior |
$878.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,003.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.81 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Adventist Health Commercial |
$423.00
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.75
|
| Rate for Payer: Multiplan Commercial |
$1,586.25
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.97 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Adventist Health Commercial |
$423.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,130.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,453.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$908.45
|
| Rate for Payer: Blue Shield of California EPN |
$730.54
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,374.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,104.23
|
| Rate for Payer: Dignity Health Senior |
$1,003.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,003.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,003.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,008.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,154.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,264.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,264.85
|
| Rate for Payer: Multiplan Commercial |
$1,586.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,003.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,003.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$790.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$790.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,505.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,104.23
|
| Rate for Payer: Vantage Medical Group Senior |
$1,003.85
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
IP
|
$2,131.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$385.71 |
| Max. Negotiated Rate |
$1,598.25 |
| Rate for Payer: Adventist Health Commercial |
$426.20
|
| Rate for Payer: Cash Price |
$1,172.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,442.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,442.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.75
|
| Rate for Payer: Multiplan Commercial |
$1,598.25
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
|
OP
|
$2,131.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$272.66 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$426.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,139.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,464.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$682.18
|
| Rate for Payer: Blue Shield of California EPN |
$548.58
|
| Rate for Payer: Cash Price |
$1,172.05
|
| Rate for Payer: Cash Price |
$1,172.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,385.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,385.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,319.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,319.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,016.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$1,598.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,065.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,065.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$286.09 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,524.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,960.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$811.44
|
| Rate for Payer: Blue Shield of California EPN |
$652.53
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,854.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,854.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,766.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,766.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,360.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,426.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,426.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
