|
HC FERRITIN
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
900910819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.05
|
| Rate for Payer: Blue Shield of California Commercial |
$106.38
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Senior |
$13.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$13.63
|
| Rate for Payer: IEHP Medi-Cal |
$18.83
|
| Rate for Payer: IEHP Medicare Advantage |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.17
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$13.63
|
|
|
HC FETAL BLEED SCREEN
|
Facility
IP
|
$312.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.22
|
| Rate for Payer: Heritage Provider Network Senior |
$211.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
|
|
HC FETAL BLEED SCREEN
|
Facility
OP
|
$312.00
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
900904562
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$214.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.03
|
| Rate for Payer: Blue Shield of California Commercial |
$51.76
|
| Rate for Payer: Blue Shield of California EPN |
$40.47
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$202.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.30
|
| Rate for Payer: Dignity Health Senior |
$9.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.13
|
| Rate for Payer: Heritage Provider Network Senior |
$193.13
|
| Rate for Payer: Humana Medicare |
$9.36
|
| Rate for Payer: IEHP Medi-Cal |
$6.51
|
| Rate for Payer: IEHP Medicare Advantage |
$9.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.36
|
| Rate for Payer: TriValley Medical Group Senior |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9.36
|
|
|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
IP
|
$724.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$497.39
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$490.15
|
| Rate for Payer: Heritage Provider Network Senior |
$490.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
|
|
HC FETAL CORD OCCLUS ADDL FETUS
|
Facility
OP
|
$724.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$497.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.60
|
| Rate for Payer: Blue Shield of California EPN |
$424.99
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.16
|
| Rate for Payer: Heritage Provider Network Senior |
$448.16
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$443.45
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$362.00
|
| Rate for Payer: TriValley Medical Group Senior |
$362.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
OP
|
$724.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$497.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.60
|
| Rate for Payer: Blue Shield of California EPN |
$424.99
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$448.16
|
| Rate for Payer: Heritage Provider Network Senior |
$448.16
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$443.45
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$362.00
|
| Rate for Payer: TriValley Medical Group Senior |
$362.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL CORD OCCLUSION
|
Facility
IP
|
$724.00
|
|
|
Service Code
|
CPT 59072
|
| Hospital Charge Code |
910400090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$543.00 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$497.39
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$490.15
|
| Rate for Payer: Heritage Provider Network Senior |
$490.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
OP
|
$1,188.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$237.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$816.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$332.58
|
| Rate for Payer: Blue Shield of California EPN |
$189.13
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$772.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.37
|
| Rate for Payer: Heritage Provider Network Senior |
$735.37
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$130.18
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC FETAL DOPPLER MID CEREBRAL ART
|
Facility
IP
|
$1,188.00
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
906601316
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$215.03 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$237.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$816.16
|
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$804.28
|
| Rate for Payer: Heritage Provider Network Senior |
$804.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$891.00
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$332.58
|
| Rate for Payer: Blue Shield of California EPN |
$189.13
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.12
|
| Rate for Payer: Heritage Provider Network Senior |
$336.12
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$60.42
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC FETAL DOPPLER UMBILICAL ARTERY
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
906601315
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC FETAL FIBRONECTIN
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$1,127.02 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$187.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$127.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,127.02
|
| Rate for Payer: Blue Shield of California Commercial |
$503.04
|
| Rate for Payer: Blue Shield of California EPN |
$393.26
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.52
|
| Rate for Payer: Heritage Provider Network Senior |
$114.52
|
| Rate for Payer: Humana Medicare |
$64.41
|
| Rate for Payer: IEHP Medi-Cal |
$87.66
|
| Rate for Payer: IEHP Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.16
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
IP
|
$1,607.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
900912319
|
|
Hospital Revenue Code
|
304
|
| Min. Negotiated Rate |
$290.87 |
| Max. Negotiated Rate |
$1,205.25 |
| Rate for Payer: Adventist Health Commercial |
$321.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,104.01
|
| Rate for Payer: Cash Price |
$723.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.94
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.75
|
| Rate for Payer: Multiplan Commercial |
$1,205.25
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.41
|
| Rate for Payer: Blue Shield of California EPN |
$637.48
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.23
|
| Rate for Payer: Heritage Provider Network Senior |
$672.23
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$523.83
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Senior |
$543.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL FLUID DRAIN INCLUD US GU
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
910400098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.22
|
| Rate for Payer: Heritage Provider Network Senior |
$735.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.88
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.02
|
| Rate for Payer: Heritage Provider Network Senior |
$329.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
|
|
HC FETAL LUNG MATURITY (FLM)
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 83663
|
| Hospital Charge Code |
900910962
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$97.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$333.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.12
|
| Rate for Payer: Blue Shield of California Commercial |
$147.74
|
| Rate for Payer: Blue Shield of California EPN |
$115.50
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$315.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.80
|
| Rate for Payer: Dignity Health Senior |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$300.83
|
| Rate for Payer: Heritage Provider Network Senior |
$300.83
|
| Rate for Payer: Humana Medicare |
$18.91
|
| Rate for Payer: IEHP Medi-Cal |
$16.32
|
| Rate for Payer: IEHP Medicare Advantage |
$18.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.83
|
| Rate for Payer: Multiplan Commercial |
$364.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.91
|
| Rate for Payer: TriValley Medical Group Senior |
$18.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.80
|
| Rate for Payer: Vantage Medical Group Senior |
$18.91
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
902400362
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$644.60
|
| Rate for Payer: Blue Shield of California EPN |
$609.31
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$674.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$642.52
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: IEHP Medi-Cal |
$68.44
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$273.87
|
| Rate for Payer: TriValley Medical Group Senior |
$248.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$554.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$882.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$570.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$778.50
|
| Rate for Payer: Blue Shield of California Commercial |
$644.60
|
| Rate for Payer: Blue Shield of California EPN |
$609.31
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$882.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.30
|
| Rate for Payer: Dignity Health Senior |
$882.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$642.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$500.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Senior |
$519.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.30
|
| Rate for Payer: Vantage Medical Group Senior |
$882.30
|
|
|
HC FETAL NON-STRESS TEST ADDL FETUS
|
Facility
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025 59
|
| Hospital Charge Code |
910400087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
OP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$644.60
|
| Rate for Payer: Blue Shield of California EPN |
$609.31
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: Dignity Health Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$248.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.52
|
| Rate for Payer: Heritage Provider Network Senior |
$642.52
|
| Rate for Payer: Humana Medicare |
$248.97
|
| Rate for Payer: IEHP Medi-Cal |
$68.44
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$473.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.70
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$519.00
|
| Rate for Payer: TriValley Medical Group Senior |
$519.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FETAL NON-STRESS TEST SINGLE FETUS
|
Facility
IP
|
$1,038.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
910400086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Adventist Health Commercial |
$207.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.11
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$702.73
|
| Rate for Payer: Heritage Provider Network Senior |
$702.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.50
|
| Rate for Payer: Multiplan Commercial |
$778.50
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.41
|
| Rate for Payer: Blue Shield of California EPN |
$637.48
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.23
|
| Rate for Payer: Heritage Provider Network Senior |
$672.23
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$443.45
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Senior |
$543.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC FETAL SHUNT PLACMNT ADDL FETUS
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 59076
|
| Hospital Charge Code |
910400093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.57 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Adventist Health Commercial |
$217.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$746.08
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$735.22
|
| Rate for Payer: Heritage Provider Network Senior |
$735.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.50
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
|
