|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
OP
|
$17,605.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906820066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,005.52 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$3,521.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,094.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| 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 |
$7,922.25
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,443.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,897.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$2,005.52
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,186.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,401.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$13,203.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| 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 |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
IP
|
$17,605.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906820066
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,186.50 |
| Max. Negotiated Rate |
$13,203.75 |
| Rate for Payer: Adventist Health Commercial |
$3,521.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,094.64
|
| Rate for Payer: Cash Price |
$7,922.25
|
| Rate for Payer: Cash Price |
$7,922.25
|
| 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 |
$3,186.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,401.25
|
| Rate for Payer: Multiplan Commercial |
$13,203.75
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
IP
|
$14,715.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,663.42 |
| Max. Negotiated Rate |
$11,036.25 |
| Rate for Payer: Adventist Health Commercial |
$2,943.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,109.20
|
| Rate for Payer: Cash Price |
$6,621.75
|
| Rate for Payer: Cash Price |
$6,621.75
|
| 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 |
$2,663.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,678.75
|
| Rate for Payer: Multiplan Commercial |
$11,036.25
|
|
|
HC RHC & LHC,CORO,W/WO LV,GRFT,IM
|
Facility
OP
|
$14,715.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
906811408
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,005.52 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$2,943.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,109.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| 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 |
$6,621.75
|
| Rate for Payer: Cash Price |
$6,621.75
|
| Rate for Payer: Cash Price |
$6,621.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,564.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,108.58
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$2,005.52
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,663.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,678.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$11,036.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| 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 |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC W/WO LV
|
Facility
IP
|
$12,393.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,243.13 |
| Max. Negotiated Rate |
$9,294.75 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| 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 |
$2,243.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
|
|
HC RHC & LHC W/WO LV
|
Facility
OP
|
$12,393.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906811400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,557.57 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,513.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cash Price |
$5,576.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,055.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,671.27
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,557.57
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,243.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,098.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$9,294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| 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 |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHC & LHC W/WO LV
|
Facility
IP
|
$16,268.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906820088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,944.51 |
| Max. Negotiated Rate |
$12,201.00 |
| Rate for Payer: Adventist Health Commercial |
$3,253.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,176.12
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cash Price |
$7,320.60
|
| 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 |
$2,944.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,067.00
|
| Rate for Payer: Multiplan Commercial |
$12,201.00
|
|
|
HC RHC & LHC W/WO LV
|
Facility
OP
|
$16,268.00
|
|
|
Service Code
|
CPT 93453
|
| Hospital Charge Code |
906820088
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,557.57 |
| Max. Negotiated Rate |
$12,201.00 |
| Rate for Payer: Adventist Health Commercial |
$3,253.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,176.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$7,320.60
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cash Price |
$7,320.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: Dignity Health Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,574.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,069.89
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,557.57
|
| Rate for Payer: IEHP Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,735.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,944.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,067.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,129.91
|
| Rate for Payer: Multiplan Commercial |
$12,201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,300.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,300.00
|
| 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 |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC RHEUMATOID FACTOR
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$46.77 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.77
|
| Rate for Payer: Blue Shield of California Commercial |
$44.33
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.24
|
| Rate for Payer: Dignity Health Senior |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: IEHP Medi-Cal |
$7.83
|
| Rate for Payer: IEHP Medicare Advantage |
$5.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.67
|
| Rate for Payer: TriValley Medical Group Senior |
$5.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.24
|
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
900910868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
OP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$213.73 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.73
|
| Rate for Payer: Blue Shield of California Commercial |
$78.10
|
| Rate for Payer: Blue Shield of California EPN |
$78.10
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Senior |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.47
|
| Rate for Payer: Heritage Provider Network Senior |
$100.47
|
| Rate for Payer: IEHP Medi-Cal |
$133.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC RH IMMUNE GLOBULIN
|
Facility
IP
|
$217.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
900904586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$99.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$79.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.50
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
OP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.10 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$301.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$241.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$329.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.73
|
| Rate for Payer: Blue Shield of California Commercial |
$78.10
|
| Rate for Payer: Blue Shield of California EPN |
$78.10
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$373.15
|
| Rate for Payer: Dignity Health Senior |
$373.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.26
|
| Rate for Payer: Heritage Provider Network Senior |
$203.26
|
| Rate for Payer: IEHP Medi-Cal |
$133.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$211.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$160.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$373.15
|
| Rate for Payer: Vantage Medical Group Senior |
$373.15
|
|
|
HC RHOGAM IMMUN GLOB 300MCG 1500I
|
Facility
IP
|
$439.00
|
|
|
Service Code
|
CPT J2790
|
| Hospital Charge Code |
910400061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Adventist Health Commercial |
$87.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$301.59
|
| Rate for Payer: Cash Price |
$197.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$201.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.20
|
| Rate for Payer: Heritage Provider Network Senior |
$297.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$329.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$160.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$146.67
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$596.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.69
|
| Rate for Payer: Blue Shield of California Commercial |
$77.62
|
| Rate for Payer: Blue Shield of California EPN |
$73.38
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: Dignity Health Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$50.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$50.11
|
| Rate for Payer: IEHP Medi-Cal |
$3.84
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$55.12
|
| Rate for Payer: TriValley Medical Group Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC RH UNIT CONFIRMATION
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904621
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$371.00 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| 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: Blue Shield of California Commercial |
$30.80
|
| Rate for Payer: Blue Shield of California EPN |
$17.52
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$255.45
|
| 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 |
$255.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.27
|
| Rate for Payer: Heritage Provider Network Senior |
$243.27
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$25.07
|
| 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 |
$71.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| 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 |
$294.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$84.06
|
| Rate for Payer: TriValley Medical Group Senior |
$76.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$371.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.00
|
| 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 RHYTHM ECG TRACING ONLY
|
Facility
IP
|
$393.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$71.13 |
| Max. Negotiated Rate |
$294.75 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
|
|
HC RHYTHM ECG TRACING ONLY
|
Facility
OP
|
$393.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
900200102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.99
|
| 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 |
$1,756.00
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$255.45
|
| 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 |
$255.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$266.06
|
| Rate for Payer: Heritage Provider Network Senior |
$266.06
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.25
|
| 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 |
$294.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.30
|
| 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 RIBS BILATERAL
|
Facility
IP
|
$801.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.28
|
| Rate for Payer: Heritage Provider Network Senior |
$542.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
|
|
HC RIBS BILATERAL
|
Facility
OP
|
$801.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
909001425
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.96 |
| Max. Negotiated Rate |
$600.75 |
| Rate for Payer: Adventist Health Commercial |
$160.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$550.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.17
|
| Rate for Payer: Blue Shield of California Commercial |
$161.94
|
| Rate for Payer: Blue Shield of California EPN |
$92.09
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cash Price |
$360.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$520.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$495.82
|
| Rate for Payer: Heritage Provider Network Senior |
$495.82
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$51.96
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$600.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC RIBS UNILATERAL
|
Facility
OP
|
$643.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$482.25 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.27
|
| Rate for Payer: Blue Shield of California Commercial |
$117.39
|
| Rate for Payer: Blue Shield of California EPN |
$66.75
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$417.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.02
|
| Rate for Payer: Heritage Provider Network Senior |
$398.02
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$42.37
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC RIBS UNILATERAL
|
Facility
IP
|
$643.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
909001376
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.38 |
| Max. Negotiated Rate |
$482.25 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.74
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.31
|
| Rate for Payer: Heritage Provider Network Senior |
$435.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.75
|
| Rate for Payer: Multiplan Commercial |
$482.25
|
|
|
HC RIGHT HEART CATH
|
Facility
IP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,691.11 |
| Max. Negotiated Rate |
$11,151.00 |
| Rate for Payer: Adventist Health Commercial |
$2,973.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,214.32
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| 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 |
$2,691.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.00
|
| Rate for Payer: Multiplan Commercial |
$11,151.00
|
|
