|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.42
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$461.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.15
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$634.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$355.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$522.20
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$461.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.15
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$355.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$480.42
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
OP
|
$7,631.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,366.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,715.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| 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: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,960.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,569.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,723.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$4,391.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,391.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,639.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,381.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,105.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,105.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,907.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$5,723.25
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| 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: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,508.51
|
| Rate for Payer: Cash Price |
$2,451.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.05
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$585.67
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$588.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Senior |
$739.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,023.96
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$755.25
|
| Rate for Payer: Blue Shield of California EPN |
$601.02
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,184.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$758.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,362.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$954.00
|
| Rate for Payer: TriValley Medical Group Senior |
$954.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
IP
|
$10,416.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,885.30 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,707.90
|
| Rate for Payer: Cash Price |
$4,687.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,051.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,051.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,885.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$7,812.00
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
OP
|
$10,416.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,885.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,437.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$4,687.20
|
| Rate for Payer: Cash Price |
$4,687.20
|
| Rate for Payer: Cash Price |
$4,687.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,770.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,447.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,929.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,885.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,812.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,274.97
|
| Rate for Payer: TriValley Medical Group Senior |
$2,274.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$1,846.50 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,585.53
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,666.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,666.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
|
|
HC BIOPSY OF SOFT TISSUE PELVIS/HIP
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 27040
|
| Hospital Charge Code |
904000006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,521.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,600.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,523.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,036.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$445.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,336.65
|
| Rate for Payer: TriValley Medical Group Senior |
$2,336.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.30 |
| Max. Negotiated Rate |
$1,559.25 |
| Rate for Payer: Adventist Health Commercial |
$415.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,338.88
|
| Rate for Payer: Cash Price |
$935.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,407.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,407.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$376.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.75
|
| Rate for Payer: Multiplan Commercial |
$1,559.25
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$415.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$987.52
|
| Rate for Payer: Blue Shield of California EPN |
$785.86
|
| Rate for Payer: Cash Price |
$935.55
|
| Rate for Payer: Cash Price |
$935.55
|
| Rate for Payer: Cash Price |
$935.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,351.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,407.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,407.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$991.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$376.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,559.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,247.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,247.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
|
OP
|
$8,074.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,461.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,989.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,248.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,035.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,997.81
|
| Rate for Payer: Heritage Provider Network Senior |
$6,194.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,568.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,461.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,791.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,018.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,539.49
|
| Rate for Payer: TriValley Medical Group Senior |
$5,539.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC BIOPSY/REMOVAL LYMPH NODE(S)
|
Facility
|
IP
|
$8,074.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
904000008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,461.39 |
| Max. Negotiated Rate |
$6,055.50 |
| Rate for Payer: Adventist Health Commercial |
$1,614.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,199.66
|
| Rate for Payer: Cash Price |
$3,633.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,466.10
|
| Rate for Payer: Heritage Provider Network Senior |
$5,466.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,461.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,018.50
|
| Rate for Payer: Multiplan Commercial |
$6,055.50
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
OP
|
$1,962.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,212.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$931.95
|
| Rate for Payer: Blue Shield of California EPN |
$741.64
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,275.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$935.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,177.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,177.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
IP
|
$1,962.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.12 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,263.53
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$482.80
|
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$351.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$269.80
|
| Rate for Payer: Blue Shield of California EPN |
$214.70
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$369.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$482.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$482.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$270.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$340.80
|
| Rate for Payer: TriValley Medical Group Senior |
$340.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.80
|
| Rate for Payer: Vantage Medical Group Senior |
$482.80
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.79
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
900501451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$365.79
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
909000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$911.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$811.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$737.79
|
| 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 |
$663.75
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$958.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,253.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,253.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$913.02
|
| Rate for Payer: Heritage Provider Network Senior |
$913.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$703.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,032.50
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$737.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$737.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,253.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,253.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,253.75
|
|
|
HC BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
CPT 11100
|
| Hospital Charge Code |
909000100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.98 |
| Max. Negotiated Rate |
$1,106.25 |
| Rate for Payer: Adventist Health Commercial |
$295.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$949.90
|
| Rate for Payer: Cash Price |
$663.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$998.58
|
| Rate for Payer: Heritage Provider Network Senior |
$998.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.75
|
| Rate for Payer: Multiplan Commercial |
$1,106.25
|
|
