|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,105.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,420.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$661.44
|
| Rate for Payer: Blue Shield of California EPN |
$531.91
|
| Rate for Payer: Cash Price |
$1,137.40
|
| Rate for Payer: Cash Price |
$1,137.40
|
| Rate for Payer: Cash Price |
$1,137.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,344.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,344.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,280.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,280.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$986.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$265.92 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,205.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,549.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$732.19
|
| Rate for Payer: Blue Shield of California EPN |
$588.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cash Price |
$1,240.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,466.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,396.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,396.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,076.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
OP
|
$1,858.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$272.55 |
| Max. Negotiated Rate |
$1,393.50 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$993.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,276.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$813.26
|
| Rate for Payer: Blue Shield of California EPN |
$654.00
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,207.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,207.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,150.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,150.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$886.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
|
IP
|
$1,858.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$336.30 |
| Max. Negotiated Rate |
$1,393.50 |
| Rate for Payer: Adventist Health Commercial |
$371.60
|
| Rate for Payer: Cash Price |
$1,021.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,257.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,257.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.50
|
| Rate for Payer: Multiplan Commercial |
$1,393.50
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
IP
|
$2,001.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.18 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,354.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,354.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
|
OP
|
$2,001.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,500.75 |
| Rate for Payer: Adventist Health Commercial |
$400.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,069.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,374.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$586.42
|
| Rate for Payer: Blue Shield of California EPN |
$471.58
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Cash Price |
$1,100.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,300.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,238.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,238.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$954.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,500.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,974.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,974.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.93 |
| Max. Negotiated Rate |
$2,187.00 |
| Rate for Payer: Adventist Health Commercial |
$583.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,558.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,003.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$993.89
|
| Rate for Payer: Blue Shield of California EPN |
$799.25
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cash Price |
$1,603.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,895.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,390.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$2,187.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
IP
|
$1,426.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$258.11 |
| Max. Negotiated Rate |
$1,069.50 |
| Rate for Payer: Adventist Health Commercial |
$285.20
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$965.40
|
| Rate for Payer: Heritage Provider Network Senior |
$965.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.50
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
|
OP
|
$1,426.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.23 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$285.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$762.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$979.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$582.10
|
| Rate for Payer: Blue Shield of California EPN |
$468.10
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Cash Price |
$784.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.69
|
| Rate for Payer: Heritage Provider Network Senior |
$882.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$680.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,069.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.52 |
| Max. Negotiated Rate |
$855.75 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Cash Price |
$627.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$772.46
|
| Rate for Payer: Heritage Provider Network Senior |
$772.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.52 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$228.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$609.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$852.48
|
| Rate for Payer: Blue Shield of California EPN |
$685.54
|
| Rate for Payer: Cash Price |
$627.55
|
| Rate for Payer: Cash Price |
$627.55
|
| Rate for Payer: Cash Price |
$627.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$741.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$706.28
|
| Rate for Payer: Heritage Provider Network Senior |
$706.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$253.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$544.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$855.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$337.84
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$123.51 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$414.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$611.52
|
| Rate for Payer: Blue Shield of California EPN |
$491.76
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$504.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.34
|
| Rate for Payer: Heritage Provider Network Senior |
$480.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| 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 |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Senior |
$105.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| 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 |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC DVLP COG SKILL 15 MIN OT MCARE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905104369
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC DVLP COG SKILL 15 MIN PT MCARE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905103369
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC DVLP COG SKILL 15 MIN PT MCARE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905103369
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$50.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.00
|
| 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 |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$105.40
|
| Rate for Payer: Dignity Health Senior |
$105.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| 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 |
$105.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$105.40
|
| Rate for Payer: Vantage Medical Group Senior |
$105.40
|
|
|
HC DVLP COG SKILL 15 MIN ST MCARE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905601809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$30.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$40.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$51.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.25
|
| 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 |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.75
|
| Rate for Payer: Dignity Health Senior |
$63.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.42
|
| Rate for Payer: Heritage Provider Network Senior |
$46.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| 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 |
$63.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.75
|
| Rate for Payer: Vantage Medical Group Senior |
$63.75
|
|
|
HC DVLP COG SKILL 15 MIN ST MCARE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT G0515
|
| Hospital Charge Code |
905601809
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.77
|
| Rate for Payer: Heritage Provider Network Senior |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$488.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$636.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$737.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$568.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| 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 |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$488.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$636.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$818.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$774.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$774.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.23
|
| Rate for Payer: Heritage Provider Network Senior |
$737.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$568.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| 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 |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$215.57 |
| Max. Negotiated Rate |
$893.25 |
| Rate for Payer: Adventist Health Commercial |
$238.20
|
| Rate for Payer: Cash Price |
$655.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.31
|
| Rate for Payer: Heritage Provider Network Senior |
$806.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
|
