|
HC BRONCH W BLLN OCC ADD LOBES
|
Facility
|
IP
|
$5,986.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900831651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,083.47 |
| Max. Negotiated Rate |
$4,489.50 |
| Rate for Payer: Adventist Health Commercial |
$1,197.20
|
| Rate for Payer: Cash Price |
$3,292.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,052.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,052.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,083.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,496.50
|
| Rate for Payer: Multiplan Commercial |
$4,489.50
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
IP
|
$5,872.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,062.83 |
| Max. Negotiated Rate |
$4,404.00 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,975.34
|
| Rate for Payer: Heritage Provider Network Senior |
$3,975.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,062.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.00
|
| Rate for Payer: Multiplan Commercial |
$4,404.00
|
|
|
HC BRONCH W/BLLN OCCLUSION
|
Facility
|
OP
|
$5,872.00
|
|
|
Service Code
|
CPT 31634
|
| Hospital Charge Code |
900803513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$13,193.53 |
| Rate for Payer: Adventist Health Commercial |
$1,174.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,034.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,581.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,865.54
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cash Price |
$3,229.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,816.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Senior |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,795.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,634.77
|
| Rate for Payer: Heritage Provider Network Senior |
$3,634.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,800.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,062.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,115.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,082.57
|
| Rate for Payer: Multiplan Commercial |
$4,404.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,675.26
|
| Rate for Payer: TriValley Medical Group Senior |
$9,675.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,936.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,936.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
OP
|
$16,363.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$16,711.81 |
| Rate for Payer: Adventist Health Commercial |
$3,272.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,241.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,795.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,999.65
|
| Rate for Payer: Cash Price |
$8,999.65
|
| Rate for Payer: Cash Price |
$8,999.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,635.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,675.26
|
| Rate for Payer: Dignity Health Senior |
$8,795.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,795.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,128.70
|
| Rate for Payer: Heritage Provider Network Senior |
$10,818.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$607.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,795.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,711.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,961.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,115.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,090.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,082.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,082.57
|
| Rate for Payer: Multiplan Commercial |
$12,272.25
|
| Rate for Payer: Multiplan WC |
$14,014.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,675.26
|
| Rate for Payer: TriValley Medical Group Senior |
$9,675.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,193.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,675.26
|
| Rate for Payer: Vantage Medical Group Senior |
$8,795.69
|
|
|
HC BRONCH W PLCMNT FIDUCIAL MRK
|
Facility
|
IP
|
$16,363.00
|
|
|
Service Code
|
CPT 31626
|
| Hospital Charge Code |
900531626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,961.70 |
| Max. Negotiated Rate |
$12,272.25 |
| Rate for Payer: Adventist Health Commercial |
$3,272.60
|
| Rate for Payer: Cash Price |
$8,999.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,077.75
|
| Rate for Payer: Heritage Provider Network Senior |
$11,077.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,961.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,090.75
|
| Rate for Payer: Multiplan Commercial |
$12,272.25
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
OP
|
$12,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,460.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,451.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,504.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,003.38
|
| Rate for Payer: Cash Price |
$6,766.10
|
| Rate for Payer: Cash Price |
$6,766.10
|
| Rate for Payer: Cash Price |
$6,766.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,996.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,684.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,614.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7,614.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,868.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,387.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,902.65
|
| Rate for Payer: Multiplan Commercial |
$9,226.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,153.10
|
| Rate for Payer: TriValley Medical Group Senior |
$5,153.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,151.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,151.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC BRONCH W/TUMOR EXCISION
|
Facility
|
IP
|
$12,302.00
|
|
|
Service Code
|
CPT 31640
|
| Hospital Charge Code |
900803516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,226.66 |
| Max. Negotiated Rate |
$9,226.50 |
| Rate for Payer: Adventist Health Commercial |
$2,460.40
|
| Rate for Payer: Cash Price |
$6,766.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,328.45
|
| Rate for Payer: Heritage Provider Network Senior |
$8,328.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,226.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,075.50
|
| Rate for Payer: Multiplan Commercial |
$9,226.50
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.41
|
| Rate for Payer: Heritage Provider Network Senior |
$179.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
|
|
HC BUFFY COAT EXAM
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 85009
|
| Hospital Charge Code |
900910196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$141.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$182.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.93
|
| Rate for Payer: Blue Shield of California Commercial |
$29.89
|
| Rate for Payer: Blue Shield of California EPN |
$23.98
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$172.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Senior |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.03
|
| Rate for Payer: Heritage Provider Network Senior |
$164.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$126.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.07
|
|
|
HC BUN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC BUN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900910253
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.02
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$36.02 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.02
|
| Rate for Payer: Blue Shield of California Commercial |
$31.74
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.34
|
| Rate for Payer: Dignity Health Senior |
$3.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.98
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.95
|
| Rate for Payer: TriValley Medical Group Senior |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.34
|
| Rate for Payer: Vantage Medical Group Senior |
$3.95
|
|
|
HC BUN BODY FLUID
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
900912241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
IP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,099.39 |
| Max. Negotiated Rate |
$4,555.50 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Cash Price |
$3,340.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,112.10
|
| Rate for Payer: Heritage Provider Network Senior |
$4,112.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,099.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,518.50
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
|
|
HC BX BREAST 1ST LESION MR IMAG
|
Facility
|
OP
|
$6,074.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
900100008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,172.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,340.70
|
| Rate for Payer: Cash Price |
$3,340.70
|
| Rate for Payer: Cash Price |
$3,340.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,948.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,759.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$269.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,099.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,518.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$4,555.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,659.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,462.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,297.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,024.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BX BREAST 1ST LESION STRTCTC
|
Facility
|
IP
|
$5,327.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
900100004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$964.19 |
| Max. Negotiated Rate |
$3,995.25 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,606.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,606.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
|
IP
|
$4,793.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.53 |
| Max. Negotiated Rate |
$3,594.75 |
| Rate for Payer: Adventist Health Commercial |
$958.60
|
| Rate for Payer: Cash Price |
$2,636.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,244.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,244.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.25
|
| Rate for Payer: Multiplan Commercial |
$3,594.75
|
|
|
HC BX BREAST 1ST LESION US IMAG
|
Facility
|
OP
|
$4,793.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
900100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$958.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,292.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,636.15
|
| Rate for Payer: Cash Price |
$2,636.15
|
| Rate for Payer: Cash Price |
$2,636.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,115.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,966.87
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$994.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,594.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
IP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,156.95 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Cash Price |
$3,515.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,327.38
|
| Rate for Payer: Heritage Provider Network Senior |
$4,327.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,156.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.00
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
|
|
HC BX BREAST ADD LESION MR IMAG
|
Facility
|
OP
|
$6,392.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
900100009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,278.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,391.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,515.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,794.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,515.60
|
| Rate for Payer: Cash Price |
$3,515.60
|
| Rate for Payer: Cash Price |
$3,515.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,154.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,433.20
|
| Rate for Payer: Dignity Health Senior |
$5,433.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,956.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,048.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,156.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,598.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,474.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,474.40
|
| Rate for Payer: Multiplan Commercial |
$4,794.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,433.20
|
| Rate for Payer: Vantage Medical Group Senior |
$5,433.20
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
OP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,659.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,929.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,995.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,462.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,527.95
|
| Rate for Payer: Dignity Health Senior |
$4,527.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,297.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,297.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$853.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,540.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,728.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,728.90
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,527.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,527.95
|
|
|
HC BX BREAST ADD LESION STRTCTC
|
Facility
|
IP
|
$5,327.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
900100005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$964.19 |
| Max. Negotiated Rate |
$3,995.25 |
| Rate for Payer: Adventist Health Commercial |
$1,065.40
|
| Rate for Payer: Cash Price |
$2,929.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,606.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,606.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$964.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.75
|
| Rate for Payer: Multiplan Commercial |
$3,995.25
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,749.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,001.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,441.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.98
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,401.70
|
| Rate for Payer: Dignity Health Senior |
$3,401.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,477.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,477.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$820.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,801.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,801.40
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,001.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,401.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,401.70
|
|
|
HC BX BREAST ADD LESION US IMAG
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
900100007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$724.36 |
| Max. Negotiated Rate |
$3,001.50 |
| Rate for Payer: Adventist Health Commercial |
$800.40
|
| Rate for Payer: Cash Price |
$2,201.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,709.35
|
| Rate for Payer: Heritage Provider Network Senior |
$2,709.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$3,001.50
|
|
