|
HC BONE AGE
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$382.50
|
| Rate for Payer: Heritage Provider Network Senior |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
|
|
HC BONE AGE
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
909001602
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$423.75 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$69.48
|
| Rate for Payer: Blue Shield of California EPN |
$39.51
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$367.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.74
|
| Rate for Payer: Heritage Provider Network Senior |
$349.74
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
IP
|
$4,851.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.03 |
| Max. Negotiated Rate |
$3,638.25 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,284.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,284.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
|
|
HC BONE BIOPSY DEEP, PERCUTAN
|
Facility
|
OP
|
$4,851.00
|
|
|
Service Code
|
CPT 20225
|
| Hospital Charge Code |
909000107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$970.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,332.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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 |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cash Price |
$2,182.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,153.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,002.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$878.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,212.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,638.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,171.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,108.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,055.40
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE BIOPSY SUPFCL, PERCUT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
909000106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.60 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,171.34
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,154.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,154.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.25
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$499.90
|
| Rate for Payer: Blue Shield of California EPN |
$472.54
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.72
|
| Rate for Payer: Heritage Provider Network Senior |
$372.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC BONE CEMENT
|
Facility
|
IP
|
$805.00
|
|
| Hospital Charge Code |
909081735
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$386.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.95
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.22 |
| Max. Negotiated Rate |
$1,136.25 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.80
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,025.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,025.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$1,136.25
|
|
|
HC BONE, FINE NEEDLE ASPIRATION
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
CPT 20615
|
| Hospital Charge Code |
909020019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,040.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$984.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$937.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$263.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,136.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BONE LENGTH
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.17
|
| Rate for Payer: Blue Shield of California Commercial |
$114.87
|
| Rate for Payer: Blue Shield of California EPN |
$65.32
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$393.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.11
|
| Rate for Payer: Heritage Provider Network Senior |
$375.11
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC BONE LENGTH
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
909001603
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.69 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$121.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$416.32
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.26
|
| Rate for Payer: Heritage Provider Network Senior |
$410.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.50
|
| Rate for Payer: Multiplan Commercial |
$454.50
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
IP
|
$1,315.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.02 |
| Max. Negotiated Rate |
$986.25 |
| Rate for Payer: Adventist Health Commercial |
$263.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$903.40
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.26
|
| Rate for Payer: Heritage Provider Network Senior |
$890.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.75
|
| Rate for Payer: Multiplan Commercial |
$986.25
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
|
OP
|
$1,315.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$263.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$903.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$591.75
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,366.82
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$240.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$986.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,905.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$835.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$898.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.65
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$305.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW BX ONLY
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.75 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$898.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$885.52
|
| Rate for Payer: Heritage Provider Network Senior |
$885.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Multiplan Commercial |
$981.00
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.47 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$310.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$822.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$416.88
|
| Rate for Payer: Blue Shield of California EPN |
$237.07
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$778.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$778.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$740.94
|
| Rate for Payer: Heritage Provider Network Senior |
$740.94
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$897.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$822.34
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.37
|
| Rate for Payer: Heritage Provider Network Senior |
$810.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.25
|
| Rate for Payer: Multiplan Commercial |
$897.75
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
|
HC BONE SCAN LIMITED
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$509.90
|
| Rate for Payer: Blue Shield of California EPN |
$289.96
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,261.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.86
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$469.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,611.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$872.17
|
| Rate for Payer: Blue Shield of California EPN |
$495.97
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,524.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,452.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,452.17
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,759.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$424.63 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,611.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,588.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,588.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.50
|
| Rate for Payer: Multiplan Commercial |
$1,759.50
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
|
IP
|
$2,294.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$415.21 |
| Max. Negotiated Rate |
$1,720.50 |
| Rate for Payer: Adventist Health Commercial |
$458.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.98
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,553.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,553.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.50
|
| Rate for Payer: Multiplan Commercial |
$1,720.50
|
|
