|
HC CROSSMATCH IS
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.17 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.78
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.42
|
| Rate for Payer: Heritage Provider Network Senior |
$464.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.50
|
| Rate for Payer: Multiplan Commercial |
$514.50
|
|
|
HC CROSSMATCH IS
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.46 |
| Max. Negotiated Rate |
$514.50 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.73
|
| Rate for Payer: Blue Shield of California Commercial |
$105.02
|
| Rate for Payer: Blue Shield of California EPN |
$84.46
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.63
|
| Rate for Payer: Heritage Provider Network Senior |
$424.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$327.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$514.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CROSSMATCH XM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$570.75 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.73
|
| Rate for Payer: Blue Shield of California Commercial |
$56.54
|
| Rate for Payer: Blue Shield of California EPN |
$45.47
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$471.06
|
| Rate for Payer: Heritage Provider Network Senior |
$471.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$363.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC CROSSMATCH XM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$570.75 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$490.08
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$515.20
|
| Rate for Payer: Heritage Provider Network Senior |
$515.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.25
|
| Rate for Payer: Multiplan Commercial |
$570.75
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$9,519.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,903.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,882.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,521.52
|
| Rate for Payer: Blue Shield of California EPN |
$3,598.18
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,187.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,444.36
|
| Rate for Payer: Heritage Provider Network Senior |
$6,444.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,540.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,722.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,379.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$7,139.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,711.40
|
| Rate for Payer: TriValley Medical Group Senior |
$5,711.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$9,519.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,722.94 |
| Max. Negotiated Rate |
$7,139.25 |
| Rate for Payer: Adventist Health Commercial |
$1,903.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,130.24
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,444.36
|
| Rate for Payer: Heritage Provider Network Senior |
$6,444.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,722.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,379.75
|
| Rate for Payer: Multiplan Commercial |
$7,139.25
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$9,519.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,722.94 |
| Max. Negotiated Rate |
$7,139.25 |
| Rate for Payer: Adventist Health Commercial |
$1,903.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,130.24
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,444.36
|
| Rate for Payer: Heritage Provider Network Senior |
$6,444.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,722.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,379.75
|
| Rate for Payer: Multiplan Commercial |
$7,139.25
|
|
|
HC CRYABLATION BONE
|
Facility
|
OP
|
$9,519.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,903.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,882.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,761.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cash Price |
$4,283.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,187.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,892.26
|
| Rate for Payer: Heritage Provider Network Senior |
$390.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$602.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,722.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,379.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$7,139.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$348.99
|
| Rate for Payer: TriValley Medical Group Senior |
$348.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
IP
|
$22,916.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,147.80 |
| Max. Negotiated Rate |
$17,187.00 |
| Rate for Payer: Adventist Health Commercial |
$4,583.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,757.90
|
| Rate for Payer: Cash Price |
$10,312.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,514.13
|
| Rate for Payer: Heritage Provider Network Senior |
$15,514.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,147.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,729.00
|
| Rate for Payer: Multiplan Commercial |
$17,187.00
|
|
|
HC CRYO ABLATE BONE TUMOR(S) PERQ
|
Facility
|
OP
|
$22,916.00
|
|
|
Service Code
|
CPT 20983
|
| Hospital Charge Code |
909020983
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,147.80 |
| Max. Negotiated Rate |
$17,732.13 |
| Rate for Payer: Adventist Health Commercial |
$4,583.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,162.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$10,312.20
|
| Rate for Payer: Cash Price |
$10,312.20
|
| Rate for Payer: Cash Price |
$10,312.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,895.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,185.00
|
| Rate for Payer: Heritage Provider Network Senior |
$11,479.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$17,732.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,147.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,729.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$17,187.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,265.97
|
| Rate for Payer: TriValley Medical Group Senior |
$10,265.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
OP
|
$16,169.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,926.59 |
| Max. Negotiated Rate |
$25,976.31 |
| Rate for Payer: Adventist Health Commercial |
$3,233.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,992.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,276.05
|
| Rate for Payer: Cash Price |
$7,276.05
|
| Rate for Payer: Cash Price |
$7,276.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,509.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,671.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,008.61
|
| Rate for Payer: Heritage Provider Network Senior |
$16,816.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,976.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,926.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,722.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,042.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$12,126.75
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,038.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC CRYOABLATION-LUNG
|
Facility
|
IP
|
$16,169.00
|
|
|
Service Code
|
CPT 32994
|
| Hospital Charge Code |
909020150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,926.59 |
| Max. Negotiated Rate |
$12,126.75 |
| Rate for Payer: Adventist Health Commercial |
$3,233.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,412.84
|
| Rate for Payer: Cash Price |
$7,276.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,946.41
|
| Rate for Payer: Heritage Provider Network Senior |
$10,946.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,926.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,042.25
|
| Rate for Payer: Multiplan Commercial |
$12,126.75
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC CRYOABLATION PROBE
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C2618
|
| Hospital Charge Code |
909020059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,950.78
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
OP
|
$15,698.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.34 |
| Max. Negotiated Rate |
$13,343.30 |
| Rate for Payer: Adventist Health Commercial |
$3,139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,701.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,633.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,773.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,064.10
|
| Rate for Payer: Cash Price |
$7,064.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,203.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,343.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,343.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,717.06
|
| Rate for Payer: Heritage Provider Network Senior |
$9,717.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,487.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,841.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,924.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,988.60
|
| Rate for Payer: Multiplan Commercial |
$11,773.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,343.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,343.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,343.30
|
|
|
HC CRYO ABLAT LIVER TUMOR
|
Facility
|
IP
|
$15,698.00
|
|
|
Service Code
|
CPT 47381
|
| Hospital Charge Code |
909000269
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.34 |
| Max. Negotiated Rate |
$11,773.50 |
| Rate for Payer: Adventist Health Commercial |
$3,139.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,109.51
|
| Rate for Payer: Cash Price |
$7,064.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,627.55
|
| Rate for Payer: Heritage Provider Network Senior |
$10,627.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,841.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,924.50
|
| Rate for Payer: Multiplan Commercial |
$11,773.50
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
OP
|
$13,046.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,361.33 |
| Max. Negotiated Rate |
$25,976.31 |
| Rate for Payer: Adventist Health Commercial |
$2,609.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,062.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,671.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,870.70
|
| Rate for Payer: Cash Price |
$5,870.70
|
| Rate for Payer: Cash Price |
$5,870.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,479.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,038.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,671.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,671.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,075.47
|
| Rate for Payer: Heritage Provider Network Senior |
$16,816.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,671.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$25,976.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,361.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,722.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,320.13
|
| Rate for Payer: Multiplan Commercial |
$9,784.50
|
| Rate for Payer: Multiplan WC |
$21,077.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,038.91
|
| Rate for Payer: TriValley Medical Group Senior |
$15,038.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,507.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,038.91
|
| Rate for Payer: Vantage Medical Group Senior |
$13,671.74
|
|
|
HC CRYO ABLAT RENAL TUMOR
|
Facility
|
IP
|
$13,046.00
|
|
|
Service Code
|
CPT 50593
|
| Hospital Charge Code |
909000268
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,361.33 |
| Max. Negotiated Rate |
$9,784.50 |
| Rate for Payer: Adventist Health Commercial |
$2,609.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,401.62
|
| Rate for Payer: Cash Price |
$5,870.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,832.14
|
| Rate for Payer: Heritage Provider Network Senior |
$8,832.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,361.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,261.50
|
| Rate for Payer: Multiplan Commercial |
$9,784.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.43
|
| Rate for Payer: Blue Shield of California EPN |
$273.29
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.47
|
| Rate for Payer: Heritage Provider Network Senior |
$489.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$344.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$433.80
|
| Rate for Payer: TriValley Medical Group Senior |
$433.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
900501637
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$542.25 |
| Rate for Payer: Adventist Health Commercial |
$144.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.61
|
| Rate for Payer: Cash Price |
$325.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$489.47
|
| Rate for Payer: Heritage Provider Network Senior |
$489.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.75
|
| Rate for Payer: Multiplan Commercial |
$542.25
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$59.83 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.83
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California Commercial |
$52.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Blue Shield of California EPN |
$41.76
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$94.71
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$72.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$29.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CRYOGLOBULINS QUAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900910978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.53
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$103.58
|
| Rate for Payer: Heritage Provider Network Senior |
$103.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
|
|
HC CSF LEAKAGE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,023.96
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC CSF LEAKAGE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
909301416
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$2,497.70 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.32
|
| Rate for Payer: Blue Shield of California Commercial |
$975.98
|
| Rate for Payer: Blue Shield of California EPN |
$784.85
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,033.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,665.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.21
|
| Rate for Payer: Heritage Provider Network Senior |
$984.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$758.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,831.64
|
| Rate for Payer: TriValley Medical Group Senior |
$1,665.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$795.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC C SPINE W/FLEX AND EXT COMPLETE
|
Facility
|
IP
|
$1,302.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
909001303
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.66 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Adventist Health Commercial |
$260.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$881.45
|
| Rate for Payer: Heritage Provider Network Senior |
$881.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.50
|
| Rate for Payer: Multiplan Commercial |
$976.50
|
|
