|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$4,296.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906820089
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$859.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,951.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,792.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,659.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,074.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,222.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$3,444.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$688.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,366.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,238.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,131.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,583.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$10,328.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,095.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,778.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,680.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,746.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,778.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,778.80
|
| Rate for Payer: Dignity Health Senior |
$8,778.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,393.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6,393.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,978.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,869.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,582.00
|
| Rate for Payer: Multiplan Commercial |
$7,746.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,778.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,778.80
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$7,597.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.06 |
| Max. Negotiated Rate |
$5,697.75 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$10,328.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,869.37 |
| Max. Negotiated Rate |
$7,746.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,095.34
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,869.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,582.00
|
| Rate for Payer: Multiplan Commercial |
$7,746.00
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$7,597.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,178.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,697.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,457.45
|
| Rate for Payer: Dignity Health Senior |
$6,457.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,702.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,702.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,661.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,457.45
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$13,810.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,499.61 |
| Max. Negotiated Rate |
$10,357.50 |
| Rate for Payer: Adventist Health Commercial |
$2,762.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,487.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,827.82
|
| Rate for Payer: Blue Shield of California EPN |
$5,551.62
|
| Rate for Payer: Cash Price |
$6,214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,349.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,349.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,499.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,452.50
|
| Rate for Payer: Multiplan Commercial |
$10,357.50
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$13,810.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$2,762.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,487.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$6,214.50
|
| Rate for Payer: Cash Price |
$6,214.50
|
| Rate for Payer: Cash Price |
$6,214.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,976.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,349.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,349.37
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,656.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,499.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,452.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$10,357.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,014.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,613.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,699.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,466.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,704.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,704.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,746.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$4,274.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,069.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,904.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,699.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,031.52 |
| Max. Negotiated Rate |
$4,274.25 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| Rate for Payer: Multiplan Commercial |
$4,274.25
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.77 |
| Max. Negotiated Rate |
$964.50 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$883.48
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$870.62
|
| Rate for Payer: Heritage Provider Network Senior |
$870.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.50
|
| Rate for Payer: Multiplan Commercial |
$964.50
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$257.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$101.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$883.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$559.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$373.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cash Price |
$578.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$835.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.51
|
| Rate for Payer: Dignity Health Senior |
$373.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$373.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$870.62
|
| Rate for Payer: Heritage Provider Network Senior |
$870.62
|
| Rate for Payer: Humana Medicare |
$373.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$373.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$619.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$470.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$470.22
|
| Rate for Payer: Multiplan Commercial |
$964.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$466.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$429.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$559.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.51
|
| Rate for Payer: Vantage Medical Group Senior |
$373.19
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$441.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$679.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$509.25 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$679.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$135.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cash Price |
$305.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$441.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.68
|
| Rate for Payer: Heritage Provider Network Senior |
$459.68
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$509.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.20
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.06
|
| Rate for Payer: Heritage Provider Network Senior |
$484.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Multiplan Commercial |
$536.25
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$491.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$464.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.06
|
| Rate for Payer: Heritage Provider Network Senior |
$484.06
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$344.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$536.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$259.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$238.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
IP
|
$12,951.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,344.13 |
| Max. Negotiated Rate |
$9,713.25 |
| Rate for Payer: Adventist Health Commercial |
$2,590.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,897.34
|
| Rate for Payer: Cash Price |
$5,827.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,767.83
|
| Rate for Payer: Heritage Provider Network Senior |
$8,767.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,344.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,237.75
|
| Rate for Payer: Multiplan Commercial |
$9,713.25
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
OP
|
$12,951.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,008.35 |
| Rate for Payer: Adventist Health Commercial |
$2,590.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,660.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,897.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,008.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,123.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,713.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$5,827.95
|
| Rate for Payer: Cash Price |
$5,827.95
|
| Rate for Payer: Cash Price |
$5,827.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,418.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,008.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,008.35
|
| Rate for Payer: Dignity Health Senior |
$11,008.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,016.67
|
| Rate for Payer: Heritage Provider Network Senior |
$8,016.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,473.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,242.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,344.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,237.75
|
| Rate for Payer: Multiplan Commercial |
$9,713.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,008.35
|
| Rate for Payer: Vantage Medical Group Senior |
$11,008.35
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.79
|
| Rate for Payer: Cash Price |
$76.50
|
| 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
|
|
