|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.32
|
| Rate for Payer: Blue Shield of California EPN |
$154.38
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Senior |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.29 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$306.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,052.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| 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 |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$995.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$948.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.29 |
| Max. Negotiated Rate |
$1,149.00 |
| Rate for Payer: Adventist Health Commercial |
$306.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,052.48
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,037.16
|
| Rate for Payer: Heritage Provider Network Senior |
$1,037.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,149.00
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
IP
|
$11,330.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,050.73 |
| Max. Negotiated Rate |
$8,497.50 |
| Rate for Payer: Adventist Health Commercial |
$2,266.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,783.71
|
| Rate for Payer: Cash Price |
$5,098.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,670.41
|
| Rate for Payer: Heritage Provider Network Senior |
$7,670.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,832.50
|
| Rate for Payer: Multiplan Commercial |
$8,497.50
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
OP
|
$11,330.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,335.00 |
| Max. Negotiated Rate |
$31,243.54 |
| Rate for Payer: Adventist Health Commercial |
$2,266.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,783.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,443.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$5,098.50
|
| Rate for Payer: Cash Price |
$5,098.50
|
| Rate for Payer: Cash Price |
$5,098.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,364.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,088.37
|
| Rate for Payer: Dignity Health Senior |
$16,443.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,443.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,013.27
|
| Rate for Payer: Heritage Provider Network Senior |
$20,226.08
|
| Rate for Payer: Humana Medicare |
$16,443.97
|
| Rate for Payer: IEHP Medi-Cal |
$5,737.88
|
| Rate for Payer: IEHP Medicare Advantage |
$16,443.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,243.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,050.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,403.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,832.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,719.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,719.40
|
| Rate for Payer: Multiplan Commercial |
$8,497.50
|
| Rate for Payer: Multiplan WC |
$22,481.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$18,088.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18,088.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,665.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,088.37
|
| Rate for Payer: Vantage Medical Group Senior |
$16,443.97
|
|
|
HC PERCU-STAY
|
Facility
OP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California EPN |
$11.15
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: Dignity Health Senior |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
HC PERCU-STAY
|
Facility
IP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
IP
|
$5,575.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$4,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| Rate for Payer: Multiplan Commercial |
$4,181.25
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
OP
|
$5,575.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,115.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,830.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cash Price |
$2,508.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,623.75
|
| 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 |
$3,774.28
|
| Rate for Payer: Heritage Provider Network Senior |
$3,774.28
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,687.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,009.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.75
|
| 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 |
$4,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,024.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,862.61
|
| 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 PERCUTANEOUS SKELETAL FIXATION
|
Facility
OP
|
$5,665.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,891.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,682.25
|
| 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 |
$3,835.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3,835.20
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,730.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.25
|
| 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 |
$4,248.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,056.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,892.68
|
| 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 PERCUTANEOUS SKELETAL FIXATION
|
Facility
IP
|
$5,665.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,025.36 |
| Max. Negotiated Rate |
$4,248.75 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,891.86
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,835.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3,835.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.25
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
OP
|
$15,461.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$395.52 |
| Max. Negotiated Rate |
$11,595.75 |
| Rate for Payer: Adventist Health Commercial |
$3,092.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,621.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,601.28
|
| Rate for Payer: Blue Shield of California EPN |
$9,075.61
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,049.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,570.36
|
| Rate for Payer: Heritage Provider Network Senior |
$9,570.36
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$395.52
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,865.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$11,595.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
IP
|
$15,461.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,798.44 |
| Max. Negotiated Rate |
$11,595.75 |
| Rate for Payer: Adventist Health Commercial |
$3,092.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,621.71
|
| Rate for Payer: Cash Price |
$6,957.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,467.10
|
| Rate for Payer: Heritage Provider Network Senior |
$10,467.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,865.25
|
| Rate for Payer: Multiplan Commercial |
$11,595.75
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
IP
|
$9,575.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.08 |
| Max. Negotiated Rate |
$7,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
OP
|
$9,575.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,223.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,615.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,476.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,199.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
IP
|
$4,264.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$771.78 |
| Max. Negotiated Rate |
$3,198.00 |
| Rate for Payer: Adventist Health Commercial |
$852.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,929.37
|
| Rate for Payer: Cash Price |
$1,918.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,886.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,886.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.00
|
| Rate for Payer: Multiplan Commercial |
$3,198.00
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
OP
|
$4,264.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$852.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,929.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,918.80
|
| Rate for Payer: Cash Price |
$1,918.80
|
| Rate for Payer: Cash Price |
$1,918.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,771.60
|
| 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 |
$2,639.42
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$313.29
|
| Rate for Payer: 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 |
$771.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,066.00
|
| 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 |
$3,198.00
|
| 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 PERICARDIOCENTESIS W/IMAGING
|
Facility
OP
|
$5,026.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,452.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$2,261.70
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,266.90
|
| 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 |
$3,111.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$313.29
|
| Rate for Payer: 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 |
$909.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.50
|
| 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 |
$3,769.50
|
| 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 PERICARDIOCENTESIS W/IMAGING
|
Facility
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$909.71 |
| Max. Negotiated Rate |
$3,769.50 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,452.86
|
| Rate for Payer: Cash Price |
$2,261.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,402.60
|
| Rate for Payer: Heritage Provider Network Senior |
$3,402.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,256.50
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$147.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.34
|
| Rate for Payer: Blue Shield of California Commercial |
$73.28
|
| Rate for Payer: Blue Shield of California EPN |
$69.27
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$53.45
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$76.42
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.54
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.03
|
| Rate for Payer: Heritage Provider Network Senior |
$373.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
|
|
HC PERITONEOGRAM
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$99.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$341.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$422.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$372.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$422.45
|
| Rate for Payer: Dignity Health Senior |
$422.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.64
|
| Rate for Payer: Heritage Provider Network Senior |
$307.64
|
| Rate for Payer: IEHP Medi-Cal |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$239.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$422.45
|
| Rate for Payer: Vantage Medical Group Senior |
$422.45
|
|
|
HC PERITONEOGRAM
|
Facility
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$2,063.25 |
| Rate for Payer: Adventist Health Commercial |
$550.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$512.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,889.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.38
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,788.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,788.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.87
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$53.87
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$2,063.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$689.28
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC PERITONEOGRAM
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$372.75 |
| Rate for Payer: Adventist Health Commercial |
$99.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$341.44
|
| Rate for Payer: Cash Price |
$223.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.47
|
| Rate for Payer: Heritage Provider Network Senior |
$336.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
|
|
HC PERITONEOGRAM
|
Facility
IP
|
$2,751.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$497.93 |
| Max. Negotiated Rate |
$2,063.25 |
| Rate for Payer: Adventist Health Commercial |
$550.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,889.94
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,862.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,862.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$2,063.25
|
|
