|
HC CERULOPLASMIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900910839
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$89.88 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.88
|
| Rate for Payer: Blue Shield of California Commercial |
$83.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.59
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$2,869.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$2,869.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$25.83
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.00
|
| Rate for Payer: TriValley Medical Group Senior |
$22.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC CERVICAL CAP REMOVAL
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
910400031
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.79
|
| Rate for Payer: Heritage Provider Network Senior |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$804.75 |
| Rate for Payer: Adventist Health Commercial |
$214.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.15
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$726.42
|
| Rate for Payer: Heritage Provider Network Senior |
$726.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.25
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
|
|
HC CERVICAL DILATOR INSERTION
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
902400113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$666.33
|
| Rate for Payer: Blue Shield of California EPN |
$629.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$697.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.19
|
| Rate for Payer: Heritage Provider Network Senior |
$664.19
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$440.90
|
| Rate for Payer: TriValley Medical Group Senior |
$400.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| 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 CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$822.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,017.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$658.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$897.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$538.65
|
| 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 |
$1,017.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,017.45
|
| Rate for Payer: Dignity Health Senior |
$1,017.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$740.94
|
| Rate for Payer: Heritage Provider Network Senior |
$740.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$576.95
|
| 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
|
| 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 |
$1,017.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,017.45
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
IP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,245.28 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,376.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,726.56
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,657.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4,657.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,245.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,720.00
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
OP
|
$6,880.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,376.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,726.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$3,096.00
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,472.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,128.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,258.72
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,245.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,720.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$287.07 |
| Max. Negotiated Rate |
$1,189.50 |
| Rate for Payer: Adventist Health Commercial |
$317.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,089.58
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,073.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,073.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.50
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.69 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$317.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,089.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,030.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$951.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$981.73
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.03 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$881.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$570.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.75
|
| 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 |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$881.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$881.45
|
| Rate for Payer: Dignity Health Senior |
$881.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$641.90
|
| Rate for Payer: Heritage Provider Network Senior |
$641.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| 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 |
$881.45
|
| Rate for Payer: Vantage Medical Group Senior |
$881.45
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$777.75 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$712.42
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.05
|
| Rate for Payer: Heritage Provider Network Senior |
$702.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.25
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$704.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| 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 |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,420.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,257.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,130.19
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$704.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,835.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,799.36
|
| Rate for Payer: TriValley Medical Group Senior |
$2,799.36
|
| 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 |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.60 |
| Max. Negotiated Rate |
$3,947.25 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
IP
|
$2,597.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$1,947.75 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,784.14
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,758.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,758.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
OP
|
$2,597.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,784.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$1,168.65
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Cash Price |
$1,168.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,688.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,607.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,423.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,947.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,615.20
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
IP
|
$5,263.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$952.60 |
| Max. Negotiated Rate |
$3,947.25 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
OP
|
$5,263.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,052.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,615.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cash Price |
$2,368.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,420.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,563.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,563.05
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,536.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$952.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$3,947.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,911.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,758.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| 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 |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Senior |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$115.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.25
|
| 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 |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.95
|
| Rate for Payer: Dignity Health Senior |
$226.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.27
|
| Rate for Payer: Heritage Provider Network Senior |
$165.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.95
|
| Rate for Payer: Vantage Medical Group Senior |
$226.95
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.33 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Adventist Health Commercial |
$53.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.43
|
| Rate for Payer: Cash Price |
$120.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.76
|
| Rate for Payer: Heritage Provider Network Senior |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$200.25
|
|
