|
HC FALLOPIAN TUBE RECANALIZATION
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
CPT 58345
|
| Hospital Charge Code |
909000177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,839.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,318.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$5,058.35
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: Cash Price |
$5,058.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,978.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,692.94
|
| Rate for Payer: Heritage Provider Network Senior |
$4,969.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,675.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,664.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,299.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$6,897.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,443.90
|
| Rate for Payer: TriValley Medical Group Senior |
$4,443.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN ADENOVIRUS
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87260
|
| Hospital Charge Code |
900911780
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.87
|
| Rate for Payer: Dignity Health Senior |
$14.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.43
|
| Rate for Payer: TriValley Medical Group Senior |
$14.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.87
|
| Rate for Payer: Vantage Medical Group Senior |
$14.43
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN BORDETELLA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87265
|
| Hospital Charge Code |
900911732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN CHLAMYDIA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87270
|
| Hospital Charge Code |
900911730
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN CMV
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.98
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Senior |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.42
|
| Rate for Payer: TriValley Medical Group Senior |
$13.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC FA STAIN CMV
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87271
|
| Hospital Charge Code |
900911784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 1
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87274
|
| Hospital Charge Code |
900911734
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC FA STAIN HERPES SIMPLEX VIRUS TYPE 2
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87273
|
| Hospital Charge Code |
900911731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN INFLUENZA A
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC FA STAIN INFLUENZA A
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87276
|
| Hospital Charge Code |
900911781
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN INFLUENZA B
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87275
|
| Hospital Charge Code |
900911782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC FA STAIN LEGIONELLA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN LEGIONELLA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87278
|
| Hospital Charge Code |
900911733
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.16
|
| Rate for Payer: Dignity Health Senior |
$15.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.16
|
| Rate for Payer: Vantage Medical Group Senior |
$15.60
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC FA STAIN PARAINFLUENZA
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
900911783
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$177.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.76
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cash Price |
$182.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.07
|
| Rate for Payer: Dignity Health Senior |
$16.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$205.51
|
| Rate for Payer: Heritage Provider Network Senior |
$205.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$158.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.70
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.43
|
| Rate for Payer: TriValley Medical Group Senior |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.43
|
|
|
HC FECAL MICROBIOTA PREP INSTIL
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906700799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$390.78 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Adventist Health Commercial |
$431.80
|
| Rate for Payer: Cash Price |
$1,187.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,461.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,461.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.75
|
| Rate for Payer: Multiplan Commercial |
$1,619.25
|
|
|
HC FECAL MICROBIOTA PREP INSTIL
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906700799
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$431.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,483.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$1,187.45
|
| Rate for Payer: Cash Price |
$1,187.45
|
| Rate for Payer: Cash Price |
$1,187.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,403.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,336.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,029.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$1,619.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
OP
|
$718.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$610.30 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$383.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$493.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$394.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$538.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.83
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$394.90
|
| Rate for Payer: Cash Price |
$394.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$466.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$610.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$610.30
|
| Rate for Payer: Dignity Health Senior |
$610.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$444.44
|
| Rate for Payer: Heritage Provider Network Senior |
$444.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$342.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.60
|
| Rate for Payer: Multiplan Commercial |
$538.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$610.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$610.30
|
| Rate for Payer: Vantage Medical Group Senior |
$610.30
|
|
|
HC FEET BOTH 1 VIEW
|
Facility
|
IP
|
$718.00
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
909001641
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$538.50 |
| Rate for Payer: Adventist Health Commercial |
$143.60
|
| Rate for Payer: Cash Price |
$394.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$486.09
|
| Rate for Payer: Heritage Provider Network Senior |
$486.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.50
|
| Rate for Payer: Multiplan Commercial |
$538.50
|
|
