|
HC IMMOBILIZER SHLDR LG
|
Facility
|
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698373
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.48
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR LG
|
Facility
|
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698373
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
|
|
HC IMMOBILIZER SHLDR MD
|
Facility
|
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698372
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
|
|
HC IMMOBILIZER SHLDR MD
|
Facility
|
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698372
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.48
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR SM
|
Facility
|
OP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698371
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.86
|
| Rate for Payer: Dignity Health Senior |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.48
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.86
|
| Rate for Payer: Vantage Medical Group Senior |
$24.86
|
|
|
HC IMMOBILIZER SHLDR SM
|
Facility
|
IP
|
$29.25
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901698371
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.76
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$21.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.68
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$114.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.01
|
| Rate for Payer: Blue Shield of California Commercial |
$113.70
|
| Rate for Payer: Blue Shield of California EPN |
$91.20
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$133.09
|
| Rate for Payer: Heritage Provider Network Senior |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$102.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC IMMUNE CELL LUMINESCENCE DET
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900912314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.56
|
| Rate for Payer: Heritage Provider Network Senior |
$145.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.75
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.83 |
| Max. Negotiated Rate |
$235.50 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$172.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$212.58
|
| Rate for Payer: Heritage Provider Network Senior |
$212.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.50
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
|
|
HC IMMUNE CELL MITOGEN STIM
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900912313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$447.51 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$167.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$215.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.51
|
| Rate for Payer: Blue Shield of California Commercial |
$394.50
|
| Rate for Payer: Blue Shield of California EPN |
$316.42
|
| Rate for Payer: Cash Price |
$172.70
|
| Rate for Payer: Cash Price |
$172.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.93
|
| Rate for Payer: Dignity Health Senior |
$49.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.37
|
| Rate for Payer: Heritage Provider Network Senior |
$194.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$149.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.78
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$49.03
|
| Rate for Payer: TriValley Medical Group Senior |
$49.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$52.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.93
|
| Rate for Payer: Vantage Medical Group Senior |
$49.03
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC IMMUNOASSAY QUAN CA 125
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
900912122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.86
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$189.86 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.86
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.23
|
| Rate for Payer: Heritage Provider Network Senior |
$105.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 15-3
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900912123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.09
|
| Rate for Payer: Heritage Provider Network Senior |
$115.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.50
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$176.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$227.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.86
|
| Rate for Payer: Blue Shield of California Commercial |
$167.44
|
| Rate for Payer: Blue Shield of California EPN |
$134.30
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$215.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$204.89
|
| Rate for Payer: Heritage Provider Network Senior |
$204.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC IMMUNOASSAY QUAN CA 19-9
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900912124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$248.25 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$182.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.09
|
| Rate for Payer: Heritage Provider Network Senior |
$224.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.75
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
|
|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC IMMUNOFLUORESCENCE STAIN EA AB
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
903800037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$398.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$512.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.90
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Blue Shield of California EPN |
$176.13
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cash Price |
$410.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.77
|
| Rate for Payer: Heritage Provider Network Senior |
$461.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.29 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$346.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$551.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.64
|
| Rate for Payer: Blue Shield of California Commercial |
$247.87
|
| Rate for Payer: Blue Shield of California EPN |
$199.33
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$421.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$551.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$551.65
|
| Rate for Payer: Dignity Health Senior |
$551.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.73
|
| Rate for Payer: Heritage Provider Network Senior |
$401.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$454.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$454.30
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$551.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$551.65
|
| Rate for Payer: Vantage Medical Group Senior |
$551.65
|
|
|
HC IMMUNOFLUORES STAIN EA ADDL
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
903800289
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.47 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Cash Price |
$356.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.37
|
| Rate for Payer: Heritage Provider Network Senior |
$439.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.25
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC IMMUNOGLOBULIN E
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900912129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$150.34 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.34
|
| Rate for Payer: Blue Shield of California Commercial |
$132.54
|
| Rate for Payer: Blue Shield of California EPN |
$106.31
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Senior |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.46
|
| Rate for Payer: TriValley Medical Group Senior |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.74
|
| Rate for Payer: Blue Shield of California Commercial |
$74.82
|
| Rate for Payer: Blue Shield of California EPN |
$60.01
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC IMMUNOGLOBULINS IGA
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC IMMUNOGLOBULINS IGG
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$97.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.51
|
| Rate for Payer: Heritage Provider Network Senior |
$120.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.50
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
|
