|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$153.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.75
|
| Rate for Payer: Dignity Health Senior |
$318.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$232.12
|
| Rate for Payer: Heritage Provider Network Senior |
$232.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.75
|
| Rate for Payer: Vantage Medical Group Senior |
$318.75
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.88 |
| Max. Negotiated Rate |
$281.25 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$206.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.88
|
| Rate for Payer: Heritage Provider Network Senior |
$253.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.75
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
|
|
HC DFIB BS DYNAGEN CRT G151
|
Facility
|
IP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$22,657.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,500.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,144.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,144.42
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,313.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,987.23
|
| Rate for Payer: Heritage Provider Network Senior |
$13,987.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,914.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,002.53
|
|
|
HC DFIB BS DYNAGEN CRT G151
|
Facility
|
OP
|
$30,210.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.00 |
| Max. Negotiated Rate |
$25,678.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14,500.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,754.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,615.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,144.42
|
| Rate for Payer: Blue Shield of California EPN |
$12,144.42
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cash Price |
$16,615.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,896.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,678.50
|
| Rate for Payer: Dignity Health Senior |
$25,678.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,334.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,987.23
|
| Rate for Payer: Heritage Provider Network Senior |
$13,987.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,105.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,105.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,552.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,147.00
|
| Rate for Payer: Multiplan Commercial |
$22,657.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,914.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,002.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,678.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25,678.50
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
|
OP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$21,312.05 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,035.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,225.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,790.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,804.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,079.35
|
| Rate for Payer: Blue Shield of California EPN |
$10,079.35
|
| Rate for Payer: Cash Price |
$13,790.15
|
| Rate for Payer: Cash Price |
$13,790.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,312.05
|
| Rate for Payer: Dignity Health Senior |
$21,312.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,046.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$11,608.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,551.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,551.10
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,058.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,301.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,312.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,312.05
|
| Rate for Payer: Vantage Medical Group Senior |
$21,312.05
|
|
|
HC DFIB BS DYNAGEN DR D153
|
Facility
|
IP
|
$25,073.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.60 |
| Max. Negotiated Rate |
$18,804.75 |
| Rate for Payer: Adventist Health Commercial |
$5,014.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,035.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,079.35
|
| Rate for Payer: Blue Shield of California EPN |
$10,079.35
|
| Rate for Payer: Cash Price |
$13,790.15
|
| Rate for Payer: Cash Price |
$13,790.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,533.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,539.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$11,608.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,536.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,536.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,268.25
|
| Rate for Payer: Multiplan Commercial |
$18,804.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,058.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,301.67
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
|
OP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$21,479.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,129.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,360.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,898.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,952.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,158.54
|
| Rate for Payer: Blue Shield of California EPN |
$10,158.54
|
| Rate for Payer: Cash Price |
$13,898.50
|
| Rate for Payer: Cash Price |
$13,898.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,479.50
|
| Rate for Payer: Dignity Health Senior |
$21,479.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,172.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,700.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,700.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,689.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,689.00
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,130.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,366.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,479.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,479.50
|
| Rate for Payer: Vantage Medical Group Senior |
$21,479.50
|
|
|
HC DFIB MED EVERA MRI DDMB1D4
|
Facility
|
IP
|
$25,270.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813758
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,054.00 |
| Max. Negotiated Rate |
$18,952.50 |
| Rate for Payer: Adventist Health Commercial |
$5,054.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,129.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,158.54
|
| Rate for Payer: Blue Shield of California EPN |
$10,158.54
|
| Rate for Payer: Cash Price |
$13,898.50
|
| Rate for Payer: Cash Price |
$13,898.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,624.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,700.01
|
| Rate for Payer: Heritage Provider Network Senior |
$11,700.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,635.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,635.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,317.50
|
| Rate for Payer: Multiplan Commercial |
$18,952.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,130.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,366.90
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
|
|
HC DFIB MED EVERA MRI DDMC3D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813759
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
|
OP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,000.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC DFIB MED EVERA MRI DVMB1D4
|
Facility
|
IP
|
$25,000.00
|
|
|
Service Code
|
CPT C1721
|
| Hospital Charge Code |
906813760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,050.00
|
| Rate for Payer: Blue Shield of California EPN |
$10,050.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,500.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,575.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,575.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,500.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,500.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,032.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,277.50
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
|
IP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$18,810.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,038.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,082.16
|
| Rate for Payer: Blue Shield of California EPN |
$10,082.16
|
| Rate for Payer: Cash Price |
$13,794.00
|
| Rate for Payer: Cash Price |
$13,794.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,543.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,612.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11,612.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,061.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,303.99
|
|
|
HC DFIB STJ QUIAD ASSUR CD3365-40Q
|
Facility
|
OP
|
$25,080.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,016.00 |
| Max. Negotiated Rate |
$21,318.00 |
| Rate for Payer: Adventist Health Commercial |
$5,016.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,038.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,229.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,794.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,810.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,082.16
|
| Rate for Payer: Blue Shield of California EPN |
$10,082.16
|
| Rate for Payer: Cash Price |
$13,794.00
|
| Rate for Payer: Cash Price |
$13,794.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,536.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,318.00
|
| Rate for Payer: Dignity Health Senior |
$21,318.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,051.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,612.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11,612.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,540.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,540.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,556.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,556.00
|
| Rate for Payer: Multiplan Commercial |
$18,810.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,061.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,303.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,318.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,318.00
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
|
IP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$17,741.25 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,354.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,509.31
|
| Rate for Payer: Blue Shield of California EPN |
$9,509.31
|
| Rate for Payer: Cash Price |
$13,010.25
|
| Rate for Payer: Cash Price |
$13,010.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,773.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,952.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,952.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,546.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,832.17
|
|
|
HC DFIB STJ UNIFY ASSURA CD3357-40C
|
Facility
|
OP
|
$23,655.00
|
|
|
Service Code
|
CPT C1882
|
| Hospital Charge Code |
906813737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.00 |
| Max. Negotiated Rate |
$20,106.75 |
| Rate for Payer: Adventist Health Commercial |
$4,731.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11,354.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,250.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,010.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,741.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,509.31
|
| Rate for Payer: Blue Shield of California EPN |
$9,509.31
|
| Rate for Payer: Cash Price |
$13,010.25
|
| Rate for Payer: Cash Price |
$13,010.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,881.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,106.75
|
| Rate for Payer: Dignity Health Senior |
$20,106.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,139.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,952.26
|
| Rate for Payer: Heritage Provider Network Senior |
$10,952.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,827.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,827.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,913.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,558.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,558.50
|
| Rate for Payer: Multiplan Commercial |
$17,741.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,546.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7,832.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,106.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,106.75
|
| Rate for Payer: Vantage Medical Group Senior |
$20,106.75
|
|
|
HC DHEA-S
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$202.95 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.95
|
| Rate for Payer: Blue Shield of California Commercial |
$178.96
|
| Rate for Payer: Blue Shield of California EPN |
$143.54
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cash Price |
$66.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: Dignity Health Senior |
$22.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.90
|
| Rate for Payer: Heritage Provider Network Senior |
$74.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$57.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.01
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.23
|
| Rate for Payer: TriValley Medical Group Senior |
$22.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
