|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$2,779.92 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,628.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,092.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.06
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.45
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,979.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,979.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,885.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,885.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,452.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,853.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,523.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,523.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.33 |
| Max. Negotiated Rate |
$2,284.50 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.50
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
OP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$150.81 |
| Max. Negotiated Rate |
$4,355.25 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,103.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,989.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,478.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,542.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,833.82
|
| Rate for Payer: Cash Price |
$3,193.85
|
| Rate for Payer: Cash Price |
$3,193.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,774.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,726.14
|
| Rate for Payer: Dignity Health Senior |
$2,478.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,774.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,478.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,594.53
|
| Rate for Payer: Heritage Provider Network Senior |
$3,594.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,478.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,769.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,850.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.67
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,726.14
|
| Rate for Payer: TriValley Medical Group Senior |
$2,478.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,903.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,903.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,717.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,726.14
|
| Rate for Payer: Vantage Medical Group Senior |
$2,478.31
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
|
IP
|
$5,807.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,051.07 |
| Max. Negotiated Rate |
$4,355.25 |
| Rate for Payer: Adventist Health Commercial |
$1,161.40
|
| Rate for Payer: Cash Price |
$3,193.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,931.34
|
| Rate for Payer: Heritage Provider Network Senior |
$3,931.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.75
|
| Rate for Payer: Multiplan Commercial |
$4,355.25
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$486.17 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,845.28
|
| 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 |
$2,427.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,951.77
|
| Rate for Payer: Cash Price |
$1,477.30
|
| Rate for Payer: Cash Price |
$1,477.30
|
| Rate for Payer: Cash Price |
$1,477.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,745.90
|
| 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 |
$1,745.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,662.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,662.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$700.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,281.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.50
|
| 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 |
$2,014.50
|
| 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 |
$1,343.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,343.00
|
| 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 NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$486.17 |
| Max. Negotiated Rate |
$2,014.50 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Cash Price |
$1,477.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,818.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,818.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.50
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.33 |
| Max. Negotiated Rate |
$4,757.81 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,092.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,757.81
|
| Rate for Payer: Blue Shield of California EPN |
$3,826.07
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,979.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,038.61
|
| Rate for Payer: Dignity Health Senior |
$1,853.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,979.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,853.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,885.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,885.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,333.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,853.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,452.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,131.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,335.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,335.13
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,038.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,853.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,523.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,523.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,779.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,038.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,853.28
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.33 |
| Max. Negotiated Rate |
$2,284.50 |
| Rate for Payer: Adventist Health Commercial |
$609.20
|
| Rate for Payer: Cash Price |
$1,675.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,062.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,062.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$551.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$761.50
|
| Rate for Payer: Multiplan Commercial |
$2,284.50
|
|
|
HC NONINVAS EST CRNRY FFR SW ANLYS CTA
|
Facility
|
IP
|
$2,317.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
909201580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$1,737.75 |
| Rate for Payer: Adventist Health Commercial |
$463.40
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,568.61
|
| Rate for Payer: Heritage Provider Network Senior |
$1,568.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.25
|
| Rate for Payer: Multiplan Commercial |
$1,737.75
|
|
|
HC NONINVAS EST CRNRY FFR SW ANLYS CTA
|
Facility
|
OP
|
$2,317.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
909201580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$5,264.50 |
| Rate for Payer: Adventist Health Commercial |
$463.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,238.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,591.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,292.70
|
| Rate for Payer: Blue Shield of California Commercial |
$5,264.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,233.53
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: Cash Price |
$1,274.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,421.97
|
| Rate for Payer: Dignity Health Senior |
$1,292.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,292.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,292.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,105.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,486.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,628.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,628.80
|
| Rate for Payer: Multiplan Commercial |
$1,737.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,158.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,158.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,939.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,421.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,292.70
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| 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 |
$148.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.75
|
| Rate for Payer: Multiplan Commercial |
$614.25
|
|
|
HC NON INVS DET HRT FAIL AUG ECHO
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 0932T
|
| Hospital Charge Code |
906811516
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$437.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$562.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| 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 |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$532.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Senior |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$381.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.96
|
| Rate for Payer: Heritage Provider Network Senior |
$468.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$724.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$480.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$480.15
|
| Rate for Payer: Multiplan Commercial |
$614.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$419.18
|
| Rate for Payer: TriValley Medical Group Senior |
$381.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$482.25
|
| 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 |
$353.65
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$417.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: Dignity Health Senior |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.02
|
| Rate for Payer: Heritage Provider Network Senior |
$398.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$306.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.10
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$482.25 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.31
|
| Rate for Payer: Heritage Provider Network Senior |
$435.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$225.34 |
| Max. Negotiated Rate |
$933.75 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Cash Price |
$684.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$842.87
|
| Rate for Payer: Heritage Provider Network Senior |
$842.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.25
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903200205
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$933.75 |
| Rate for Payer: Adventist Health Commercial |
$510.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$855.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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: Cash Price |
$684.75
|
| Rate for Payer: Cash Price |
$684.75
|
| Rate for Payer: Cash Price |
$684.75
|
| Rate for Payer: Cash Price |
$684.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$809.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$770.65
|
| Rate for Payer: Heritage Provider Network Senior |
$770.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$593.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| 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 |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Adventist Health Commercial |
$160.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$209.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT COMM MCARE
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900411040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
