|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$3,392.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.95 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: Adventist Health Commercial |
$678.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,330.30
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,296.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,296.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.00
|
| Rate for Payer: Multiplan Commercial |
$2,544.00
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
OP
|
$5,583.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.03 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,116.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,835.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,628.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,455.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,010.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,395.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
IP
|
$5,583.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,010.52 |
| Max. Negotiated Rate |
$4,187.25 |
| Rate for Payer: Adventist Health Commercial |
$1,116.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,835.52
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,779.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,779.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,010.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,395.75
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
IP
|
$18,920.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,424.52 |
| Max. Negotiated Rate |
$14,190.00 |
| Rate for Payer: Adventist Health Commercial |
$3,784.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,998.04
|
| Rate for Payer: Cash Price |
$8,514.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,808.84
|
| Rate for Payer: Heritage Provider Network Senior |
$12,808.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,424.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,730.00
|
| Rate for Payer: Multiplan Commercial |
$14,190.00
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
OP
|
$18,920.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$864.21 |
| Max. Negotiated Rate |
$14,190.00 |
| Rate for Payer: Adventist Health Commercial |
$3,784.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,998.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$8,514.00
|
| Rate for Payer: Cash Price |
$8,514.00
|
| Rate for Payer: Cash Price |
$8,514.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,298.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$864.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,424.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,730.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$14,190.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$16,403.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,968.94 |
| Max. Negotiated Rate |
$12,302.25 |
| Rate for Payer: Adventist Health Commercial |
$3,280.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,268.86
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| 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 |
$2,968.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.75
|
| Rate for Payer: Multiplan Commercial |
$12,302.25
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$16,403.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$514.75 |
| Max. Negotiated Rate |
$13,942.55 |
| Rate for Payer: Adventist Health Commercial |
$3,280.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,268.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,942.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,021.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,302.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,942.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,942.55
|
| Rate for Payer: Dignity Health Senior |
$13,942.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,661.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,153.46
|
| Rate for Payer: Heritage Provider Network Senior |
$10,153.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,906.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,968.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.75
|
| Rate for Payer: Multiplan Commercial |
$12,302.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,942.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,942.55
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$208.51 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$230.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$791.42
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| 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 |
$208.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$208.51 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$230.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$791.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$979.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$633.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$979.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$979.20
|
| Rate for Payer: Dignity Health Senior |
$979.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.09
|
| Rate for Payer: Heritage Provider Network Senior |
$713.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$555.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$979.20
|
| Rate for Payer: Vantage Medical Group Senior |
$979.20
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,033.20 |
| Max. Negotiated Rate |
$12,568.50 |
| Rate for Payer: Adventist Health Commercial |
$3,351.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,512.75
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| 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 |
$3,033.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,189.50
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$16,403.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,968.94 |
| Max. Negotiated Rate |
$12,302.25 |
| Rate for Payer: Adventist Health Commercial |
$3,280.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,268.86
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| 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 |
$2,968.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.75
|
| Rate for Payer: Multiplan Commercial |
$12,302.25
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$16,403.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$514.49 |
| Max. Negotiated Rate |
$13,942.55 |
| Rate for Payer: Adventist Health Commercial |
$3,280.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,268.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,942.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,021.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,302.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cash Price |
$7,381.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,942.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,942.55
|
| Rate for Payer: Dignity Health Senior |
$13,942.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,661.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,153.46
|
| Rate for Payer: Heritage Provider Network Senior |
$10,153.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,906.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,968.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,100.75
|
| Rate for Payer: Multiplan Commercial |
$12,302.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,942.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,942.55
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$16,758.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$514.49 |
| Max. Negotiated Rate |
$14,244.30 |
| Rate for Payer: Adventist Health Commercial |
$3,351.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,512.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,216.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,568.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cash Price |
$7,541.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,244.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,244.30
|
| Rate for Payer: Dignity Health Senior |
$14,244.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,892.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,373.20
|
| Rate for Payer: Heritage Provider Network Senior |
$10,373.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$514.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,077.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,033.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,189.50
|
| Rate for Payer: Multiplan Commercial |
$12,568.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,244.30
|
| Rate for Payer: Vantage Medical Group Senior |
$14,244.30
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.70
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| 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 |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$555.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.63
|
| Rate for Payer: Heritage Provider Network Senior |
$362.41
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$324.10
|
| Rate for Payer: TriValley Medical Group Senior |
$324.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$5,583.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,010.52 |
| Max. Negotiated Rate |
$4,187.25 |
| Rate for Payer: Adventist Health Commercial |
$1,116.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,835.52
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,779.69
|
| Rate for Payer: Heritage Provider Network Senior |
$3,779.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,010.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,395.75
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
OP
|
$5,583.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.73 |
| Max. Negotiated Rate |
$7,096.00 |
| Rate for Payer: Adventist Health Commercial |
$1,116.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,835.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cash Price |
$2,512.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,628.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: Dignity Health Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,412.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,455.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,967.23
|
| Rate for Payer: Humana Medicare |
$2,412.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,583.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,010.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,395.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,039.60
|
| Rate for Payer: Multiplan Commercial |
$4,187.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,653.62
|
| Rate for Payer: TriValley Medical Group Senior |
$2,653.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
OP
|
$34,148.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$25,611.00 |
| Rate for Payer: Adventist Health Commercial |
$6,829.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,459.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,196.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,137.61
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,180.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,537.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$25,611.00
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC ABL IE GT 1 TMR PER ORGN INC IG
|
Facility
|
IP
|
$34,148.00
|
|
|
Service Code
|
CPT 0600T
|
| Hospital Charge Code |
909000600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,180.79 |
| Max. Negotiated Rate |
$25,611.00 |
| Rate for Payer: Adventist Health Commercial |
$6,829.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,459.68
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,118.20
|
| Rate for Payer: Heritage Provider Network Senior |
$23,118.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,180.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,537.00
|
| Rate for Payer: Multiplan Commercial |
$25,611.00
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$34,148.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$25,611.00 |
| Rate for Payer: Adventist Health Commercial |
$6,829.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,459.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,196.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,137.61
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,180.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,537.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$25,611.00
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
IP
|
$34,148.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,180.79 |
| Max. Negotiated Rate |
$25,611.00 |
| Rate for Payer: Adventist Health Commercial |
$6,829.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,459.68
|
| Rate for Payer: Cash Price |
$15,366.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,118.20
|
| Rate for Payer: Heritage Provider Network Senior |
$23,118.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,180.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,537.00
|
| Rate for Payer: Multiplan Commercial |
$25,611.00
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$303.24 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.96
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.75
|
| Rate for Payer: Heritage Provider Network Senior |
$167.75
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ABO BLOOD GROUP
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.42
|
| Rate for Payer: Blue Shield of California Commercial |
$168.29
|
| Rate for Payer: Blue Shield of California EPN |
$159.08
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.75
|
| Rate for Payer: Heritage Provider Network Senior |
$167.75
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
