|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
IP
|
$1,315.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.02 |
| Max. Negotiated Rate |
$986.25 |
| Rate for Payer: Adventist Health Commercial |
$263.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$903.40
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.26
|
| Rate for Payer: Heritage Provider Network Senior |
$890.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.75
|
| Rate for Payer: Multiplan Commercial |
$986.25
|
|
|
HC BONE MARROW ASP/AT TIME OF BX
|
Facility
OP
|
$1,315.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
911800314
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$263.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$903.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Cash Price |
$591.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$813.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,366.82
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: IEHP Medi-Cal |
$240.55
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,745.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$986.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,905.29
|
| Rate for Payer: TriValley Medical Group Senior |
$3,905.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$835.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$795.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$286.32
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW ASP ONLY
|
Facility
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
911800312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.58 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Adventist Health Commercial |
$257.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.80
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.94
|
| Rate for Payer: Heritage Provider Network Senior |
$869.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.25
|
| Rate for Payer: Multiplan Commercial |
$963.75
|
|
|
HC BONE MARROW BX ONLY
|
Facility
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.75 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$898.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$885.52
|
| Rate for Payer: Heritage Provider Network Senior |
$885.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Multiplan Commercial |
$981.00
|
|
|
HC BONE MARROW BX ONLY
|
Facility
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
909020057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$898.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$850.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.65
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$305.49
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$981.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
OP
|
$1,197.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.47 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$310.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$822.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$416.88
|
| Rate for Payer: Blue Shield of California EPN |
$237.07
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$778.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$778.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$740.94
|
| Rate for Payer: Heritage Provider Network Senior |
$740.94
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$145.47
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$897.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE MARROW IMAGING, LTD
|
Facility
IP
|
$1,197.00
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
909301330
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.66 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Adventist Health Commercial |
$239.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$822.34
|
| Rate for Payer: Cash Price |
$538.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$810.37
|
| Rate for Payer: Heritage Provider Network Senior |
$810.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.25
|
| Rate for Payer: Multiplan Commercial |
$897.75
|
|
|
HC BONE SCAN LIMITED
|
Facility
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
|
HC BONE SCAN LIMITED
|
Facility
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
909301370
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$126.22 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$509.90
|
| Rate for Payer: Blue Shield of California EPN |
$289.96
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,261.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.86
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$126.22
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
OP
|
$2,346.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$469.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,611.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$872.17
|
| Rate for Payer: Blue Shield of California EPN |
$495.97
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,524.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,524.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,452.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,452.17
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$220.01
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,759.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC BONE SCAN WHOLE BODY
|
Facility
IP
|
$2,346.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
909301371
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$424.63 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$469.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,611.70
|
| Rate for Payer: Cash Price |
$1,055.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,588.24
|
| Rate for Payer: Heritage Provider Network Senior |
$1,588.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.50
|
| Rate for Payer: Multiplan Commercial |
$1,759.50
|
|
|
HC BONE SURVEY COMPLETE
|
Facility
OP
|
$2,294.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,720.50 |
| Rate for Payer: Adventist Health Commercial |
$458.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.98
|
| 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 |
$1,032.30
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,491.10
|
| 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 |
$1,491.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,419.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,419.99
|
| 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 |
$415.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,720.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$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 BONE SURVEY COMPLETE
|
Facility
IP
|
$2,294.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$415.21 |
| Max. Negotiated Rate |
$1,720.50 |
| Rate for Payer: Adventist Health Commercial |
$458.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,575.98
|
| Rate for Payer: Cash Price |
$1,032.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,553.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,553.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$573.50
|
| Rate for Payer: Multiplan Commercial |
$1,720.50
|
|
|
HC BONE SURVEY INFANT
|
Facility
OP
|
$834.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$148.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| 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 |
$177.56
|
| Rate for Payer: Blue Shield of California Commercial |
$346.28
|
| Rate for Payer: Blue Shield of California EPN |
$196.92
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$542.10
|
| 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 |
$542.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.25
|
| Rate for Payer: Heritage Provider Network Senior |
$516.25
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$99.22
|
| 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 |
$150.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$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 BONE SURVEY INFANT
|
Facility
IP
|
$834.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
900077076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.95 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$166.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.96
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$564.62
|
| Rate for Payer: Heritage Provider Network Senior |
$564.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.50
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
|
|
HC BOTOX INJECTION
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$379.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$379.36
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BOTOX INJECTION
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,005.82 |
| Max. Negotiated Rate |
$4,167.75 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
OP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,670.78
|
| 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 |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,580.80
|
| 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 |
$1,459.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,505.41
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$134.04
|
| 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 |
$440.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.00
|
| 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 |
$1,824.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
IP
|
$2,432.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Adventist Health Commercial |
$486.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,670.78
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,646.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,646.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.00
|
| Rate for Payer: Multiplan Commercial |
$1,824.00
|
|
|
HC BRAF
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$406.35 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.35
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$118.57
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: IEHP Medi-Cal |
$121.62
|
| Rate for Payer: IEHP Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAF
|
Facility
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800312
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$212.25 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.42
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.59
|
| Rate for Payer: Heritage Provider Network Senior |
$191.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.75
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
|
|
HC BRAF PACKAGE
|
Facility
IP
|
$283.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$212.25 |
| Rate for Payer: Adventist Health Commercial |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$194.42
|
| Rate for Payer: Cash Price |
$127.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.59
|
| Rate for Payer: Heritage Provider Network Senior |
$191.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.75
|
| Rate for Payer: Multiplan Commercial |
$212.25
|
|
|
HC BRAF PACKAGE
|
Facility
OP
|
$202.00
|
|
|
Service Code
|
CPT 81210
|
| Hospital Charge Code |
903800313
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.56 |
| Max. Negotiated Rate |
$406.35 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$138.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$175.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.35
|
| Rate for Payer: Blue Shield of California Commercial |
$125.44
|
| Rate for Payer: Blue Shield of California EPN |
$118.57
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$131.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.94
|
| Rate for Payer: Dignity Health Senior |
$175.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.04
|
| Rate for Payer: Heritage Provider Network Senior |
$125.04
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: IEHP Medi-Cal |
$121.62
|
| Rate for Payer: IEHP Medicare Advantage |
$175.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.40
|
| Rate for Payer: TriValley Medical Group Senior |
$175.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.94
|
| Rate for Payer: Vantage Medical Group Senior |
$175.40
|
|
|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$864.75 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.11
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$780.58
|
| Rate for Payer: Heritage Provider Network Senior |
$780.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
|
