|
HC EX BENIGN LES 1.0 - 2.0 CM
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
900501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,001.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$769.50
|
| Rate for Payer: Blue Shield of California EPN |
$612.36
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,053.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$772.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Senior |
$972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$2,061.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,273.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$978.98
|
| Rate for Payer: Blue Shield of California EPN |
$779.06
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$983.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,236.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,236.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EX BENIGN LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$2,061.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
900501586
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.04 |
| Max. Negotiated Rate |
$1,545.75 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,327.28
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$373.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.25
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$420.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,300.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$999.40
|
| Rate for Payer: Blue Shield of California EPN |
$795.31
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,367.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,424.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,003.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$1,578.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,262.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,262.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EX BENIGN LES LT 0.5 CM SCALP
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
900501014
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.82 |
| Max. Negotiated Rate |
$1,578.00 |
| Rate for Payer: Adventist Health Commercial |
$420.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,354.98
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,424.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.00
|
| Rate for Payer: Multiplan Commercial |
$1,578.00
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
IP
|
$3,795.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$686.89 |
| Max. Negotiated Rate |
$2,846.25 |
| Rate for Payer: Adventist Health Commercial |
$759.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,443.98
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,569.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,569.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$686.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$948.75
|
| Rate for Payer: Multiplan Commercial |
$2,846.25
|
|
|
HC EXC BEN LES-HD/HND/FT 3.1-4.CM
|
Facility
|
OP
|
$3,795.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
900501737
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$686.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$759.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,345.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,802.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,434.51
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cash Price |
$1,707.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,466.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,569.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,569.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,810.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$686.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$948.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,846.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,277.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,277.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
IP
|
$1,362.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$1,021.50 |
| Rate for Payer: Adventist Health Commercial |
$272.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$877.13
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$922.07
|
| Rate for Payer: Heritage Provider Network Senior |
$922.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.50
|
| Rate for Payer: Multiplan Commercial |
$1,021.50
|
|
|
HC EXC BEN LES TRUNK 0.6-1.0 CM
|
Facility
|
OP
|
$1,362.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
900501242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$272.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$841.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$646.95
|
| Rate for Payer: Blue Shield of California EPN |
$514.84
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cash Price |
$612.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$885.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$922.07
|
| Rate for Payer: Heritage Provider Network Senior |
$922.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$649.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,021.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$817.20
|
| Rate for Payer: TriValley Medical Group Senior |
$817.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$761.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$585.67
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$801.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$588.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Senior |
$739.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EXC BEN LES TRUNK LT 0.5 CM
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
900501287
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.17 |
| Max. Negotiated Rate |
$924.75 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$794.05
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$834.74
|
| Rate for Payer: Heritage Provider Network Senior |
$834.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$223.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$922.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.17
|
| Rate for Payer: Blue Shield of California EPN |
$564.35
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$970.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$712.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,119.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$895.80
|
| Rate for Payer: TriValley Medical Group Senior |
$895.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC EXC FACIAL LESION 0.6-1.0 CM
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
900501588
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$1,119.75 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$961.49
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.75
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.06
|
| Rate for Payer: Blue Shield of California Commercial |
$183.00
|
| Rate for Payer: Blue Shield of California EPN |
$146.40
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$143.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC EXCHANGE STEERABLE GW
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$708.07 |
| Max. Negotiated Rate |
$2,934.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,519.33
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,648.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,648.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
|
|
HC EXCISION OF GUM LESION
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
900501744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$708.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$782.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,417.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,478.74
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cash Price |
$1,760.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,542.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,648.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,648.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,866.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$708.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,934.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,347.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,347.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$836.95
|
| Rate for Payer: Blue Shield of California EPN |
$666.04
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,145.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$840.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,057.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC EXCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 41115
|
| Hospital Charge Code |
900501757
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$1,321.50 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,134.73
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,192.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,192.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.50
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
OP
|
$4,628.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$6,245.00 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,860.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,198.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,749.38
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,008.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,008.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,207.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$837.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,776.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,776.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EXCISION/REPAIR EYELID GT 1/4
|
Facility
|
IP
|
$4,628.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
900501712
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$3,471.00 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,980.43
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$837.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$2,913.75 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,501.94
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
|
|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,400.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.53
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,525.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,853.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,331.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$5,446.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,365.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,586.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,058.59
|
| Rate for Payer: Cash Price |
$2,450.70
|
| Rate for Payer: Cash Price |
$2,450.70
|
| Rate for Payer: Cash Price |
$2,450.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,539.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,539.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,686.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,686.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,597.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$985.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,769.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$4,084.50
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,267.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,267.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$5,446.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$985.73 |
| Max. Negotiated Rate |
$4,084.50 |
| Rate for Payer: Adventist Health Commercial |
$1,089.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,507.22
|
| Rate for Payer: Cash Price |
$2,450.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,686.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,686.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$985.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.50
|
| Rate for Payer: Multiplan Commercial |
$4,084.50
|
|
