|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$1,415.43 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$918.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,180.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,415.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,140.77
|
| Rate for Payer: Blue Shield of California EPN |
$917.37
|
| Rate for Payer: Cash Price |
$945.45
|
| Rate for Payer: Cash Price |
$945.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,117.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,117.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$819.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$785.56
|
| Rate for Payer: TriValley Medical Group Senior |
$785.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC LYMPHANGIOGRAM EXT UNILAT
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 75801
|
| Hospital Charge Code |
909001375
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.14 |
| Max. Negotiated Rate |
$1,289.25 |
| Rate for Payer: Adventist Health Commercial |
$343.80
|
| Rate for Payer: Cash Price |
$945.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,163.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,163.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.34 |
| Max. Negotiated Rate |
$5,998.81 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,380.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,774.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,585.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,283.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,032.47
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,678.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,678.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,598.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,598.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$224.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,232.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,999.21
|
| Rate for Payer: TriValley Medical Group Senior |
$3,999.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LYMPHANGIOGRAM, PELV BILAT
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 75807
|
| Hospital Charge Code |
909001365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.52 |
| Max. Negotiated Rate |
$1,937.25 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,748.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,748.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$645.75
|
| Rate for Payer: Multiplan Commercial |
$1,937.25
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Senior |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$732.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC LYMPHANGIOGRAPHY INJECTION
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
909000131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$354.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
IP
|
$2,405.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.31 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Cash Price |
$1,322.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,628.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,628.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
|
|
HC LYMPHAT/ANTIMONY SCA
|
Facility
|
OP
|
$2,405.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
909301341
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$307.07 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Adventist Health Commercial |
$481.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,285.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,652.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$857.95
|
| Rate for Payer: Blue Shield of California EPN |
$689.94
|
| Rate for Payer: Cash Price |
$1,322.75
|
| Rate for Payer: Cash Price |
$1,322.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,563.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,488.69
|
| Rate for Payer: Heritage Provider Network Senior |
$1,488.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,147.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$1,803.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,202.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,202.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
OP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,688.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,274.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,927.23
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$239.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,244.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,025.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,797.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,352.03
|
| Rate for Payer: TriValley Medical Group Senior |
$5,352.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, DP AX
|
Facility
|
IP
|
$11,191.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
909000129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,025.57 |
| Max. Negotiated Rate |
$8,393.25 |
| Rate for Payer: Adventist Health Commercial |
$2,238.20
|
| Rate for Payer: Cash Price |
$6,155.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,576.31
|
| Rate for Payer: Heritage Provider Network Senior |
$7,576.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,025.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,797.75
|
| Rate for Payer: Multiplan Commercial |
$8,393.25
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,983.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,660.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,390.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$234.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,244.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,352.03
|
| Rate for Payer: TriValley Medical Group Senior |
$5,352.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, DP CE
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
909000128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$6,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,895.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5,895.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
OP
|
$8,709.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,983.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,660.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Senior |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,865.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,390.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,984.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,244.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,595.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,130.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,130.50
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,352.03
|
| Rate for Payer: TriValley Medical Group Senior |
$5,352.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC LYMPH NODE NDLE BPSY, INT M
|
Facility
|
IP
|
$8,709.00
|
|
|
Service Code
|
CPT 38530
|
| Hospital Charge Code |
909000130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,576.33 |
| Max. Negotiated Rate |
$6,531.75 |
| Rate for Payer: Adventist Health Commercial |
$1,741.80
|
| Rate for Payer: Cash Price |
$4,789.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,895.99
|
| Rate for Payer: Heritage Provider Network Senior |
$5,895.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,177.25
|
| Rate for Payer: Multiplan Commercial |
$6,531.75
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.44 |
| Max. Negotiated Rate |
$1,593.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,437.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,437.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
|
|
HC LYMPH NODE NDLE BPSY,SUPFCL
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
909000127
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$424.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,459.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,168.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,380.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,314.76
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$531.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,593.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOG
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900914187
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.82
|
| Rate for Payer: Heritage Provider Network Senior |
$184.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOG
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
900914187
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$447.51 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$187.55
|
| 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 |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$177.45
|
| 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 |
$177.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.99
|
| Rate for Payer: Heritage Provider Network Senior |
$168.99
|
| 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 |
$130.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.25
|
| 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 |
$204.75
|
| 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 LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$4,641.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,016.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Senior |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,039.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,213.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,645.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,090.29
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,669.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,536.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC LYSIS OF LABIAL ADHESIONS
|
Facility
|
IP
|
$4,641.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
902400744
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$840.02 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Adventist Health Commercial |
$928.20
|
| Rate for Payer: Cash Price |
$2,552.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,141.96
|
| Rate for Payer: Heritage Provider Network Senior |
$3,141.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$840.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,160.25
|
| Rate for Payer: Multiplan Commercial |
$3,480.75
|
|
|
HC MAGNESIUM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC MAGNESIUM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.79
|
| Rate for Payer: Blue Shield of California Commercial |
$53.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.70
|
| Rate for Payer: TriValley Medical Group Senior |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Adventist Health Commercial |
$334.20
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,131.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,131.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$1,253.25
|
|
|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$302.45 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Adventist Health Commercial |
$334.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$893.15
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,147.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.52
|
| Rate for Payer: Blue Shield of California EPN |
$824.69
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: Cash Price |
$919.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$322.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$797.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,253.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.70
|
| Rate for Payer: Blue Shield of California Commercial |
$48.21
|
| Rate for Payer: Blue Shield of California EPN |
$38.67
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
