|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,792.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Adventist Health Commercial |
$358.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,231.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.38
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,164.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,164.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,109.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,109.25
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,344.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,008.52
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$993.84
|
| Rate for Payer: Heritage Provider Network Senior |
$993.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$535.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$490.46
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,247.80 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$807.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.04
|
| Rate for Payer: Blue Shield of California Commercial |
$911.63
|
| Rate for Payer: Blue Shield of California EPN |
$861.72
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,247.80
|
| Rate for Payer: Dignity Health Senior |
$1,247.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.68
|
| Rate for Payer: Heritage Provider Network Senior |
$679.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$363.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$707.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$587.20
|
| Rate for Payer: TriValley Medical Group Senior |
$587.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$535.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$490.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,247.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,247.80
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$277.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$254.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$250.49
|
| Rate for Payer: Heritage Provider Network Senior |
$250.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.62
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.97 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.91
|
| Rate for Payer: Blue Shield of California Commercial |
$229.77
|
| Rate for Payer: Blue Shield of California EPN |
$217.19
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.50
|
| Rate for Payer: Dignity Health Senior |
$314.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.31
|
| Rate for Payer: Heritage Provider Network Senior |
$171.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$178.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.50
|
| Rate for Payer: Multiplan Commercial |
$277.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.00
|
| Rate for Payer: TriValley Medical Group Senior |
$148.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$134.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$123.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.50
|
| Rate for Payer: Vantage Medical Group Senior |
$314.50
|
|
|
HC I-125 SEED
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.05
|
| Rate for Payer: Heritage Provider Network Senior |
$178.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
|
|
HC I-125 SEED
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.32
|
| Rate for Payer: Blue Shield of California EPN |
$154.38
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Senior |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.48
|
| Rate for Payer: Blue Shield of California Commercial |
$272.00
|
| Rate for Payer: Blue Shield of California EPN |
$257.11
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Senior |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.79
|
| Rate for Payer: Heritage Provider Network Senior |
$202.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$211.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.28 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$300.91
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$236.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$296.53
|
| Rate for Payer: Heritage Provider Network Senior |
$296.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.34
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
IP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,041.29 |
| Max. Negotiated Rate |
$4,314.75 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,952.31
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,106.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,894.78
|
| Rate for Payer: Heritage Provider Network Senior |
$3,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.25
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,097.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,922.08
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$719.10 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,164.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,314.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$929.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,572.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,377.01
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,890.05
|
| Rate for Payer: Dignity Health Senior |
$4,890.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,681.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,663.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,663.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$719.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,772.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.25
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,301.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,301.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,097.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,922.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,890.05
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$34.21 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.95
|
| Rate for Payer: Heritage Provider Network Senior |
$127.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.14
|
|
|
HC I-131 SODIUM IODIDE SOL/MCI TH
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT A9530
|
| Hospital Charge Code |
909301569
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.40
|
| Rate for Payer: Blue Shield of California Commercial |
$117.37
|
| Rate for Payer: Blue Shield of California EPN |
$110.94
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.44
|
| Rate for Payer: Dignity Health Senior |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.99
|
| Rate for Payer: Heritage Provider Network Senior |
$116.99
|
| Rate for Payer: Humana Medicare |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$38.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.70
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.44
|
| Rate for Payer: TriValley Medical Group Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.44
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,371.62 |
| Max. Negotiated Rate |
$5,683.50 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,167.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,683.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,925.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,441.30
|
| Rate for Payer: Dignity Health Senior |
$6,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,925.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,690.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,690.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$847.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,652.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,441.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,441.30
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
OP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906811333
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,167.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,683.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,925.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,441.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,441.30
|
| Rate for Payer: Dignity Health Senior |
$6,441.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,925.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,690.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,690.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$847.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,652.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,441.30
|
| Rate for Payer: Vantage Medical Group Senior |
$6,441.30
|
|
|
HC ICD GEN & LEAD TEST @ IMPLANT
|
Facility
|
IP
|
$7,578.00
|
|
|
Service Code
|
CPT 93641
|
| Hospital Charge Code |
906820051
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,371.62 |
| Max. Negotiated Rate |
$5,683.50 |
| Rate for Payer: Adventist Health Commercial |
$1,515.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.09
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Cash Price |
$3,410.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,894.50
|
| Rate for Payer: Multiplan Commercial |
$5,683.50
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$4,788.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.63 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$957.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,289.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,069.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,633.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,591.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,154.60
|
| Rate for Payer: Cash Price |
$2,154.60
|
| Rate for Payer: Cash Price |
$2,154.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,112.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,069.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,069.80
|
| Rate for Payer: Dignity Health Senior |
$4,069.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,963.77
|
| Rate for Payer: Heritage Provider Network Senior |
$2,963.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,397.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,307.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.00
|
| Rate for Payer: Multiplan Commercial |
$3,591.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,069.80
|
| Rate for Payer: Vantage Medical Group Senior |
$4,069.80
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$4,788.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906811339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$866.63 |
| Max. Negotiated Rate |
$3,591.00 |
| Rate for Payer: Adventist Health Commercial |
$957.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,289.36
|
| Rate for Payer: Cash Price |
$2,154.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,241.48
|
| Rate for Payer: Heritage Provider Network Senior |
$3,241.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,197.00
|
| Rate for Payer: Multiplan Commercial |
$3,591.00
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906820107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,134.87 |
| Max. Negotiated Rate |
$4,702.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,307.49
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,244.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4,244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,702.50
|
|
|
HC ICD GEN &/OR LEAD REMOVE, THOR
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 33243
|
| Hospital Charge Code |
906820107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,134.87 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,307.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,329.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,448.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,702.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,075.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,329.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,329.50
|
| Rate for Payer: Dignity Health Senior |
$5,329.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,881.13
|
| Rate for Payer: Heritage Provider Network Senior |
$3,881.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,397.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,022.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,134.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,567.50
|
| Rate for Payer: Multiplan Commercial |
$4,702.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,329.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,329.50
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906820122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,078.22 |
| Max. Negotiated Rate |
$4,467.75 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,032.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4,032.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906820122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$1,191.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,092.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,872.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,687.38
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,078.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,489.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
OP
|
$12,150.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,897.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: Dignity Health Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,906.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,520.85
|
| Rate for Payer: Heritage Provider Network Senior |
$6,035.04
|
| Rate for Payer: Humana Medicare |
$4,906.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,322.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,789.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,182.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,182.24
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,397.19
|
| Rate for Payer: TriValley Medical Group Senior |
$5,397.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC ICD GEN REMOVE ONLY
|
Facility
|
IP
|
$12,150.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
906811372
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,199.15 |
| Max. Negotiated Rate |
$9,112.50 |
| Rate for Payer: Adventist Health Commercial |
$2,430.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,347.05
|
| Rate for Payer: Cash Price |
$5,467.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,225.55
|
| Rate for Payer: Heritage Provider Network Senior |
$8,225.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,037.50
|
| Rate for Payer: Multiplan Commercial |
$9,112.50
|
|
