|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$608.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$829.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| 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 |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.10
|
| Rate for Payer: Dignity Health Senior |
$940.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.61
|
| Rate for Payer: Heritage Provider Network Senior |
$684.61
|
| Rate for Payer: IEHP Medi-Cal |
$410.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$533.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.10
|
| Rate for Payer: Vantage Medical Group Senior |
$940.10
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: IEHP Medi-Cal |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$810.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$702.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: Dignity Health Senior |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$669.14
|
| Rate for Payer: Heritage Provider Network Senior |
$669.14
|
| Rate for Payer: IEHP Medi-Cal |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$521.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| 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 |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$810.75 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.65
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.84
|
| Rate for Payer: Heritage Provider Network Senior |
$731.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$389.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$358.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$201.79 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$201.79
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
IP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,143.94 |
| Max. Negotiated Rate |
$8,883.75 |
| Rate for Payer: Adventist Health Commercial |
$2,369.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,137.52
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,019.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.25
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
OP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$201.79 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,137.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,699.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,699.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,332.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7,332.06
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$201.79
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$382.54
|
| Rate for Payer: Blue Shield of California EPN |
$361.59
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.40
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$381.30
|
| Rate for Payer: Heritage Provider Network Senior |
$381.30
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$59.23
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| 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 |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$370.06
|
| 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 ARTHO ASP &/OR INJ INTER JOINT
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.40
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$296.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| 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 |
$462.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$223.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$205.81
|
| 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 ARTHO ASP &/OR INJ SM JOINT
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare 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 |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.75
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.16
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$50.53
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| 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 |
$401.25
|
| 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 ARTHO ASP &/OR INJ SM JOINT
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$401.25 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.20
|
| Rate for Payer: Heritage Provider Network Senior |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$401.25 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.20
|
| Rate for Payer: Heritage Provider Network Senior |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cash Price |
$240.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$347.75
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.20
|
| Rate for Payer: Heritage Provider Network Senior |
$362.20
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$257.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.75
|
| 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 |
$401.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$194.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$178.74
|
| 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 ARTHRDSIS POST INTRBDY LMBR
|
Facility
OP
|
$58,563.00
|
|
|
Service Code
|
CPT 22630
|
| Hospital Charge Code |
900100963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,754.56 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Adventist Health Commercial |
$11,712.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,232.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$26,353.35
|
| Rate for Payer: Cash Price |
$26,353.35
|
| Rate for Payer: Cash Price |
$26,353.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38,065.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,250.50
|
| Rate for Payer: Heritage Provider Network Senior |
$28,639.96
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$1,754.56
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,599.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: Multiplan Commercial |
$43,922.25
|
| Rate for Payer: Multiplan WC |
$31,833.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$25,612.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
HC ARTHRDSIS POST INTRBDY LMBR
|
Facility
IP
|
$58,563.00
|
|
|
Service Code
|
CPT 22630
|
| Hospital Charge Code |
900100963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,599.90 |
| Max. Negotiated Rate |
$43,922.25 |
| Rate for Payer: Adventist Health Commercial |
$11,712.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40,232.78
|
| Rate for Payer: Cash Price |
$26,353.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$39,647.15
|
| Rate for Payer: Heritage Provider Network Senior |
$39,647.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,599.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,640.75
|
| Rate for Payer: Multiplan Commercial |
$43,922.25
|
|
|
HC ARTHRITIS SERIES
|
Facility
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,340.25 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,227.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.54
|
| Rate for Payer: Blue Shield of California Commercial |
$399.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.18
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,161.55
|
| 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 |
$1,161.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,106.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,106.15
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$122.46
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.75
|
| 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 |
$1,340.25
|
| 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 |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 ARTHRITIS SERIES
|
Facility
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.45 |
| Max. Negotiated Rate |
$1,340.25 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,227.67
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,209.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,209.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.75
|
| Rate for Payer: Multiplan Commercial |
$1,340.25
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
OP
|
$40,882.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,860.27 |
| Max. Negotiated Rate |
$44,240.59 |
| Rate for Payer: Adventist Health Commercial |
$8,176.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,085.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23,284.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$18,396.90
|
| Rate for Payer: Cash Price |
$18,396.90
|
| Rate for Payer: Cash Price |
$18,396.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26,573.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,612.97
|
| Rate for Payer: Dignity Health Senior |
$23,284.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,284.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,305.96
|
| Rate for Payer: Heritage Provider Network Senior |
$28,639.96
|
| Rate for Payer: Humana Medicare |
$23,284.52
|
| Rate for Payer: IEHP Medi-Cal |
$1,860.27
|
| Rate for Payer: IEHP Medicare Advantage |
$23,284.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,240.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,399.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,220.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,338.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,338.50
|
| Rate for Payer: Multiplan Commercial |
$30,661.50
|
| Rate for Payer: Multiplan WC |
$31,833.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,612.97
|
| Rate for Payer: TriValley Medical Group Senior |
$25,612.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,926.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,612.97
|
| Rate for Payer: Vantage Medical Group Senior |
$23,284.52
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
IP
|
$40,882.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,399.64 |
| Max. Negotiated Rate |
$30,661.50 |
| Rate for Payer: Adventist Health Commercial |
$8,176.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,085.93
|
| Rate for Payer: Cash Price |
$18,396.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,677.11
|
| Rate for Payer: Heritage Provider Network Senior |
$27,677.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,399.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,220.50
|
| Rate for Payer: Multiplan Commercial |
$30,661.50
|
|
