|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$39.56
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.44 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Adventist Health Commercial |
$71.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$244.57
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.01
|
| Rate for Payer: Heritage Provider Network Senior |
$241.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
IP
|
$2,964.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$536.48 |
| Max. Negotiated Rate |
$4,765.00 |
| Rate for Payer: Adventist Health Commercial |
$592.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,036.27
|
| Rate for Payer: Blue Shield of California Commercial |
$4,765.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,085.00
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,006.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,006.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$2,223.00
|
|
|
HC NID
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC NID
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.52
|
| Rate for Payer: Blue Shield of California EPN |
$143.23
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$158.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Senior |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$151.04
|
| Rate for Payer: Heritage Provider Network Senior |
$151.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$167.63
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.19
|
| Rate for Payer: Heritage Provider Network Senior |
$165.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
OP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$3,282.00 |
| Rate for Payer: Adventist Health Commercial |
$875.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,338.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,006.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,717.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,568.71
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,844.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,844.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,708.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,708.74
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$3,282.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC NITRIC OXIDE/HELIOX THRPY PER DAY
|
Facility
IP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$792.06 |
| Max. Negotiated Rate |
$3,282.00 |
| Rate for Payer: Adventist Health Commercial |
$875.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,006.31
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,962.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,962.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.00
|
| Rate for Payer: Multiplan Commercial |
$3,282.00
|
|
|
HC NMIC306
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NMIC306
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
IP
|
$5,883.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,064.82 |
| Max. Negotiated Rate |
$4,412.25 |
| Rate for Payer: Adventist Health Commercial |
$1,176.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,041.62
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,982.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,982.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.75
|
| Rate for Payer: Multiplan Commercial |
$4,412.25
|
|
|
HC NM MYCRD IMG PET RST & STRS CT
|
Facility
OP
|
$5,883.00
|
|
|
Service Code
|
CPT 78431
|
| Hospital Charge Code |
909308431
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$124.96 |
| Max. Negotiated Rate |
$5,607.22 |
| Rate for Payer: Adventist Health Commercial |
$1,176.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,041.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,951.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,653.34
|
| Rate for Payer: Blue Shield of California EPN |
$3,453.32
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Cash Price |
$2,647.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,823.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,246.29
|
| Rate for Payer: Dignity Health Senior |
$2,951.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,823.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,951.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,641.58
|
| Rate for Payer: Heritage Provider Network Senior |
$3,641.58
|
| Rate for Payer: Humana Medicare |
$2,951.17
|
| Rate for Payer: IEHP Medi-Cal |
$124.96
|
| Rate for Payer: IEHP Medicare Advantage |
$2,951.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,607.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,482.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,470.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,718.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,718.47
|
| Rate for Payer: Multiplan Commercial |
$4,412.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,246.29
|
| Rate for Payer: TriValley Medical Group Senior |
$2,951.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,426.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,246.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2,951.17
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.73 |
| Max. Negotiated Rate |
$2,829.00 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,553.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,553.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
|
|
HC NM MYCRD IMG PET RST/STRS W/CT
|
Facility
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78430
|
| Hospital Charge Code |
909308430
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$107.30 |
| Max. Negotiated Rate |
$3,713.89 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,342.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,214.16
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,451.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,334.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,334.87
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: IEHP Medi-Cal |
$107.30
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,150.15
|
| Rate for Payer: TriValley Medical Group Senior |
$1,954.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$3,713.89 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,342.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,214.16
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,451.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,334.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,334.87
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: IEHP Medi-Cal |
$113.10
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,150.15
|
| Rate for Payer: TriValley Medical Group Senior |
$1,954.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM MYOCRD IMG PET 1 STUDY W/CT
|
Facility
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78429
|
| Hospital Charge Code |
909308429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.73 |
| Max. Negotiated Rate |
$2,829.00 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,553.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,553.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,648.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,557.77
|
| Rate for Payer: Blue Shield of California Commercial |
$4,466.23
|
| Rate for Payer: Blue Shield of California EPN |
$4,221.70
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,813.55
|
| Rate for Payer: Dignity Health Senior |
$2,557.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,674.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,557.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$4,451.85
|
| Rate for Payer: Humana Medicare |
$2,557.77
|
| Rate for Payer: IEHP Medi-Cal |
$145.28
|
| Rate for Payer: IEHP Medicare Advantage |
$2,557.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,859.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,018.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,222.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,222.79
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,813.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,557.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,836.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,813.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,557.77
|
|
|
HC NM MYOCRD IMG PET DUAL TRCR CT
|
Facility
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 78433
|
| Hospital Charge Code |
909308433
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$602.01 |
| Max. Negotiated Rate |
$3,370.88 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,284.96
|
| 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 |
$2,356.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,339.95
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,161.90
|
| 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 |
$2,161.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,774.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,058.79
|
| Rate for Payer: Heritage Provider Network Senior |
$2,058.79
|
| Rate for Payer: Humana Medicare |
$1,774.15
|
| Rate for Payer: IEHP Medi-Cal |
$674.64
|
| 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 |
$602.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,093.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.50
|
| 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 |
$2,494.50
|
| 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 NM RP LCLZTN TMR SPECT W/CT 1
|
Facility
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 78830
|
| Hospital Charge Code |
909308830
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$602.01 |
| Max. Negotiated Rate |
$2,494.50 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,284.96
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,251.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,251.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$602.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.50
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
OP
|
$3,772.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.73 |
| Max. Negotiated Rate |
$4,619.04 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,954.68
|
| Rate for Payer: Blue Shield of California Commercial |
$4,619.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,626.71
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,451.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.15
|
| Rate for Payer: Dignity Health Senior |
$1,954.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,451.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,954.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,334.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,334.87
|
| Rate for Payer: Humana Medicare |
$1,954.68
|
| Rate for Payer: IEHP Medi-Cal |
$1,283.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,954.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,713.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,306.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,462.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,462.90
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,150.15
|
| Rate for Payer: TriValley Medical Group Senior |
$1,954.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,932.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,954.68
|
|
|
HC NM RP LCLZTN TMR SPECT W/CT 2
|
Facility
IP
|
$3,772.00
|
|
|
Service Code
|
CPT 78832
|
| Hospital Charge Code |
909308832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.73 |
| Max. Negotiated Rate |
$2,829.00 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,553.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,553.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
|
|
HC NONINVAS EST CRNRY FFR SW ANLYS CTA
|
Facility
IP
|
$2,869.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
909201580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$519.29 |
| Max. Negotiated Rate |
$2,151.75 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,942.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,942.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.25
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
|
|
HC NONINVAS EST CRNRY FFR SW ANLYS CTA
|
Facility
OP
|
$2,869.00
|
|
|
Service Code
|
CPT 75580
|
| Hospital Charge Code |
909201580
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,482.03 |
| Rate for Payer: Adventist Health Commercial |
$573.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,533.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,971.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,781.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,684.10
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cash Price |
$1,291.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: Dignity Health Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,306.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Humana Medicare |
$1,306.33
|
| Rate for Payer: IEHP Medicare Advantage |
$1,306.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,482.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$519.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,541.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,645.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,645.98
|
| Rate for Payer: Multiplan Commercial |
$2,151.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
