|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC AERO INHAL SPUTUM IND INITIAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| 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 |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SPUTUM IND SUB
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900801011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$211.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.14
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.48
|
| Rate for Payer: Heritage Provider Network Senior |
$315.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
|
|
HC AERO INHAL SVN INITIAL
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| 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 |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.45
|
| Rate for Payer: Heritage Provider Network Senior |
$288.45
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$506.33 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| 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 |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$302.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: Dignity Health Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$266.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.45
|
| Rate for Payer: Heritage Provider Network Senior |
$288.45
|
| Rate for Payer: Humana Medicare |
$266.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$314.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.78
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC AERO INHAL SVN SUB
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
900800311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.14
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.48
|
| Rate for Payer: Heritage Provider Network Senior |
$315.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.50
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC AFB FLUOROCHROME STAIN CONCEN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911546
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| 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 |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| 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 |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB FLUOROCHROME STAIN DIRECT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911545
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC AFB ZIEHL-NEELSEN STAIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911544
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.97
|
| Rate for Payer: Blue Shield of California Commercial |
$41.92
|
| Rate for Payer: Blue Shield of California EPN |
$32.78
|
| 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 |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.79
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.39
|
| Rate for Payer: TriValley Medical Group Senior |
$5.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC AFB ZIEHL-NEELSEN STAIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900911544
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
OP
|
$3,727.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$745.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,560.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,167.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,049.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,795.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,314.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,187.75
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,422.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,167.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,167.95
|
| Rate for Payer: Dignity Health Senior |
$3,167.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,307.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,307.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,796.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.75
|
| Rate for Payer: Multiplan Commercial |
$2,795.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,863.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,863.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,167.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,167.95
|
|
|
HC AIRWAY BRONCH STENT SUB
|
Facility
|
IP
|
$3,727.00
|
|
|
Service Code
|
CPT 31637
|
| Hospital Charge Code |
900803518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.59 |
| Max. Negotiated Rate |
$2,795.25 |
| Rate for Payer: Adventist Health Commercial |
$745.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,560.45
|
| Rate for Payer: Cash Price |
$1,677.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,523.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,523.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.75
|
| Rate for Payer: Multiplan Commercial |
$2,795.25
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
OP
|
$6,723.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.83 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,344.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,618.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,174.98
|
| Rate for Payer: Blue Shield of California EPN |
$3,946.40
|
| Rate for Payer: Cash Price |
$3,025.35
|
| Rate for Payer: Cash Price |
$3,025.35
|
| Rate for Payer: Cash Price |
$3,025.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,369.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,161.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,161.54
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,680.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$5,042.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY DIALATN BRONCH STNT INT
|
Facility
|
IP
|
$6,723.00
|
|
|
Service Code
|
CPT 31636
|
| Hospital Charge Code |
900803517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,216.86 |
| Max. Negotiated Rate |
$5,042.25 |
| Rate for Payer: Adventist Health Commercial |
$1,344.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,618.70
|
| Rate for Payer: Cash Price |
$3,025.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,551.47
|
| Rate for Payer: Heritage Provider Network Senior |
$4,551.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,680.75
|
| Rate for Payer: Multiplan Commercial |
$5,042.25
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
IP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,851.99 |
| Max. Negotiated Rate |
$7,674.00 |
| Rate for Payer: Adventist Health Commercial |
$2,046.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,029.38
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,927.06
|
| Rate for Payer: Heritage Provider Network Senior |
$6,927.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.00
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
|
|
HC AIRWAY DILATION WO STENT
|
Facility
|
OP
|
$10,232.00
|
|
|
Service Code
|
CPT 31630
|
| Hospital Charge Code |
900803450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,046.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,029.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cash Price |
$4,604.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,650.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,333.61
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$348.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,851.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$7,674.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
IP
|
$6,915.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,251.62 |
| Max. Negotiated Rate |
$5,186.25 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,750.60
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,681.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,681.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.75
|
| Rate for Payer: Multiplan Commercial |
$5,186.25
|
|
|
HC AIRWAY DILATION W STENT
|
Facility
|
OP
|
$6,915.00
|
|
|
Service Code
|
CPT 31631
|
| Hospital Charge Code |
900803451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.02 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,383.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,750.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cash Price |
$3,111.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,494.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,280.38
|
| Rate for Payer: Heritage Provider Network Senior |
$10,518.34
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$5,186.25
|
| Rate for Payer: Multiplan WC |
$11,691.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
OP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$16,247.85 |
| Rate for Payer: Adventist Health Commercial |
$1,309.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,496.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,064.44
|
| Rate for Payer: Blue Shield of California EPN |
$3,841.92
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,254.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: Dignity Health Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,551.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,051.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,051.36
|
| Rate for Payer: Humana Medicare |
$8,551.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$246.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,247.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,184.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,090.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,636.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,774.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,774.89
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,406.65
|
| Rate for Payer: TriValley Medical Group Senior |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
IP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,184.64 |
| Max. Negotiated Rate |
$4,908.75 |
| Rate for Payer: Adventist Health Commercial |
$1,309.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,496.42
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,430.96
|
| Rate for Payer: Heritage Provider Network Senior |
$4,430.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,184.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,636.25
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
|
|
HC ALBUMIN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900910220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
