|
HC MYELOGRAM, COMPLETE
|
Facility
OP
|
$2,372.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$1,900.76 |
| Rate for Payer: Adventist Health Commercial |
$474.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$332.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,629.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.46
|
| Rate for Payer: Blue Shield of California EPN |
$708.82
|
| Rate for Payer: Cash Price |
$1,067.40
|
| Rate for Payer: Cash Price |
$1,067.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,541.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,468.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,468.27
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$176.16
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,779.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,000.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAM, COMPLETE
|
Facility
IP
|
$2,372.00
|
|
|
Service Code
|
CPT 72270
|
| Hospital Charge Code |
909001364
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.33 |
| Max. Negotiated Rate |
$1,779.00 |
| Rate for Payer: Adventist Health Commercial |
$474.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,629.56
|
| Rate for Payer: Cash Price |
$1,067.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,605.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,605.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.00
|
| Rate for Payer: Multiplan Commercial |
$1,779.00
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
OP
|
$2,043.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.78 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,403.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,327.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,225.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,264.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,230.49
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT 2 OR GT LVLS
|
Facility
IP
|
$2,043.00
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
909062305
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.78 |
| Max. Negotiated Rate |
$1,532.25 |
| Rate for Payer: Adventist Health Commercial |
$408.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,403.54
|
| Rate for Payer: Cash Price |
$919.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,383.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,383.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.75
|
| Rate for Payer: Multiplan Commercial |
$1,532.25
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
OP
|
$1,754.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.01 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,052.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,085.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,230.49
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$169.01
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT C-SPINE
|
Facility
IP
|
$1,754.00
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
909062302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.47 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.00
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,187.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,187.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.58 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Adventist Health Commercial |
$547.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,881.01
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,853.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,853.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.50
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
|
|
HC MYELOGRAPHY LUMBAR INJECT L-SPINE
|
Facility
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
909062304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.58 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$547.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,881.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,779.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,642.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,694.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,230.49
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
IP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.58 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Adventist Health Commercial |
$547.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,881.01
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,853.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,853.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.50
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
|
|
HC MYELOGRAPHY LUMBAR INJECT T-SPINE
|
Facility
OP
|
$2,738.00
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
909062303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.33 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$547.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,881.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cash Price |
$1,232.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,779.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,642.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,694.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,230.49
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$171.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$2,053.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,100.44
|
| Rate for Payer: TriValley Medical Group Senior |
$1,100.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
IP
|
$1,758.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$318.20 |
| Max. Negotiated Rate |
$1,318.50 |
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.75
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,190.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,190.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.50
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
|
|
HC MYELOGRAPHY, LUMBOSACRAL
|
Facility
OP
|
$1,758.00
|
|
|
Service Code
|
CPT 72265
|
| Hospital Charge Code |
909001372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$1,900.76 |
| Rate for Payer: Adventist Health Commercial |
$351.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$216.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$971.15
|
| Rate for Payer: Blue Shield of California Commercial |
$832.93
|
| Rate for Payer: Blue Shield of California EPN |
$473.66
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cash Price |
$791.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,088.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,088.20
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$127.89
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,318.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,000.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
IP
|
$2,619.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$474.04 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,773.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,773.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
|
|
HC MYELOGRAPHY, THORACIC
|
Facility
OP
|
$2,619.00
|
|
|
Service Code
|
CPT 72255
|
| Hospital Charge Code |
909001371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$204.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,500.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,000.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,032.35
|
| Rate for Payer: Blue Shield of California Commercial |
$881.95
|
| Rate for Payer: Blue Shield of California EPN |
$501.54
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,702.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,500.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,100.44
|
| Rate for Payer: Dignity Health Senior |
$1,000.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,702.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,000.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,621.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,621.16
|
| Rate for Payer: Humana Medicare |
$1,000.40
|
| Rate for Payer: IEHP Medi-Cal |
$135.75
|
| Rate for Payer: IEHP Medicare Advantage |
$1,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,900.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,180.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,260.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,260.50
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,000.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,000.40
|
| 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 |
$1,500.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,100.44
|
| Rate for Payer: Vantage Medical Group Senior |
$1,000.40
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
IP
|
$1,951.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.13 |
| Max. Negotiated Rate |
$1,463.25 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,320.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
|
|
HC MYOCARDIAL PERFUSION MULTIPLE TEST
|
Facility
OP
|
$1,951.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
909301383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.56 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$390.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$798.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,340.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$662.28
|
| Rate for Payer: Blue Shield of California EPN |
$376.62
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cash Price |
$877.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,268.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,268.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,207.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,207.67
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$262.56
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$1,463.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
OP
|
$2,870.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$574.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$544.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Blue Shield of California Commercial |
$787.77
|
| Rate for Payer: Blue Shield of California EPN |
$447.98
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,865.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: Dignity Health Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,865.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,776.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,776.53
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$275.50
|
| Rate for Payer: IEHP Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,370.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.43
|
| Rate for Payer: Multiplan Commercial |
$2,152.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,951.56
|
| Rate for Payer: TriValley Medical Group Senior |
$1,774.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC MYOCARDIAL PERFUSION SINGLE
|
Facility
IP
|
$2,870.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$519.47 |
| Max. Negotiated Rate |
$2,152.50 |
| Rate for Payer: Adventist Health Commercial |
$574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.69
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,942.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,942.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.50
|
| Rate for Payer: Multiplan Commercial |
$2,152.50
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC MYOCARD INFAR/PYP
|
Facility
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 78466
|
| Hospital Charge Code |
909301382
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$323.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$533.43
|
| Rate for Payer: Blue Shield of California EPN |
$303.35
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,340.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,276.38
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$136.53
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC MYOFACIAL RELEASE SOFT TISSUE OT
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
CPT 97250
|
| Hospital Charge Code |
905104148
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$172.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$273.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$241.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$273.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.70
|
| Rate for Payer: Dignity Health Senior |
$273.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.32
|
| Rate for Payer: Heritage Provider Network Senior |
$199.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.70
|
| Rate for Payer: Vantage Medical Group Senior |
$273.70
|
|
|
HC MYOFACIAL RELEASE SOFT TISSUE OT
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
CPT 97250
|
| Hospital Charge Code |
905104148
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Adventist Health Commercial |
$64.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.21
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$217.99
|
| Rate for Payer: Heritage Provider Network Senior |
$217.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$241.50
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC MYOGLOBIN SCREEN
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
900910387
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.82
|
| Rate for Payer: Blue Shield of California Commercial |
$17.55
|
| Rate for Payer: Blue Shield of California EPN |
$13.72
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.48
|
| Rate for Payer: Dignity Health Senior |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6.81
|
| Rate for Payer: Humana Medicare |
$2.25
|
| Rate for Payer: IEHP Medi-Cal |
$3.06
|
| Rate for Payer: IEHP Medicare Advantage |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$8.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.25
|
| Rate for Payer: TriValley Medical Group Senior |
$2.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.48
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
HC MYOGLOBIN (SERUM)
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
900910825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$108.42 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.42
|
| Rate for Payer: Blue Shield of California Commercial |
$100.84
|
| Rate for Payer: Blue Shield of California EPN |
$78.83
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.21
|
| Rate for Payer: Dignity Health Senior |
$12.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: IEHP Medi-Cal |
$17.91
|
| Rate for Payer: IEHP Medicare Advantage |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.28
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.92
|
| Rate for Payer: TriValley Medical Group Senior |
$12.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Vantage Medical Group Senior |
$12.92
|
|
