|
HC RIGHT HEART CATH
|
Facility
OP
|
$12,393.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,089.86 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$2,478.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| 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 |
$5,505.00
|
| 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 |
$1,089.86
|
| 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 RIGHT HEART CATH
|
Facility
IP
|
$12,393.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906811398
|
|
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 RIGHT HEART CATH
|
Facility
OP
|
$14,868.00
|
|
|
Service Code
|
CPT 93451
|
| Hospital Charge Code |
906820057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,089.86 |
| Max. Negotiated Rate |
$11,566.00 |
| Rate for Payer: Adventist Health Commercial |
$2,973.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,214.32
|
| 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 |
$5,505.00
|
| 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 |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| Rate for Payer: Cash Price |
$6,690.60
|
| 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 |
$9,664.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,071.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,203.29
|
| Rate for Payer: Heritage Provider Network Senior |
$5,007.77
|
| Rate for Payer: Humana Medicare |
$4,071.36
|
| Rate for Payer: IEHP Medi-Cal |
$1,089.86
|
| 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 |
$2,691.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,804.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.00
|
| 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 |
$11,151.00
|
| 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 RIGIFLEX OTW BALLOON DILATOR
|
Facility
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.02 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,695.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.51
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Senior |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,315.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX OTW BALLOON DILATOR
|
Facility
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,848.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,848.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
OP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.02 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,320.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,501.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,047.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,695.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,602.51
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,774.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,320.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,320.50
|
| Rate for Payer: Dignity Health Senior |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,689.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,689.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,315.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,320.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,320.50
|
|
|
HC RIGIFLEX TTS BALLOON DILATOR
|
Facility
IP
|
$2,730.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$494.13 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: Adventist Health Commercial |
$546.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.51
|
| Rate for Payer: Cash Price |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,848.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,848.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$2,047.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
IP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.13 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.20
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$572.74
|
| Rate for Payer: Heritage Provider Network Senior |
$572.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
|
|
HC RI RED CELL UTILIZAT
|
Facility
OP
|
$846.00
|
|
| Hospital Charge Code |
909301338
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.13 |
| Max. Negotiated Rate |
$719.10 |
| Rate for Payer: Adventist Health Commercial |
$169.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$452.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$634.50
|
| Rate for Payer: Blue Shield of California Commercial |
$525.37
|
| Rate for Payer: Blue Shield of California EPN |
$496.60
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$549.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: Dignity Health Senior |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$523.67
|
| Rate for Payer: Heritage Provider Network Senior |
$523.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$407.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.50
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
IP
|
$9,374.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,696.69 |
| Max. Negotiated Rate |
$7,030.50 |
| Rate for Payer: Adventist Health Commercial |
$1,874.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,439.94
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,346.20
|
| Rate for Payer: Heritage Provider Network Senior |
$6,346.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,696.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,343.50
|
| Rate for Payer: Multiplan Commercial |
$7,030.50
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
OP
|
$9,374.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,874.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,439.94
|
| 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 |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cash Price |
$4,218.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,093.10
|
| 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 |
$5,802.51
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$841.56
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,696.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,343.50
|
| 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 |
$7,030.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| 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 RMVL BRONCH VALVE ADDL LOBES
|
Facility
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.41 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| 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 |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,627.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,502.62
|
| Rate for Payer: Heritage Provider Network Senior |
$2,608.36
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: IEHP Medi-Cal |
$96.41
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,332.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,332.68
|
| 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 Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
OP
|
$7,743.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,548.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,319.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,032.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: Dignity Health Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,678.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,792.92
|
| Rate for Payer: Heritage Provider Network Senior |
$5,755.08
|
| Rate for Payer: Humana Medicare |
$4,678.93
|
| Rate for Payer: IEHP Medi-Cal |
$304.34
|
| Rate for Payer: IEHP Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,889.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,521.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,895.45
|
| Rate for Payer: Multiplan Commercial |
$5,807.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,146.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5,146.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
IP
|
$7,743.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,401.48 |
| Max. Negotiated Rate |
$5,807.25 |
| Rate for Payer: Adventist Health Commercial |
$1,548.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,319.44
|
| Rate for Payer: Cash Price |
$3,484.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.01
|
| Rate for Payer: Heritage Provider Network Senior |
$5,242.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,401.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,935.75
|
| Rate for Payer: Multiplan Commercial |
$5,807.25
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
OP
|
$4,921.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$984.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,380.73
|
| 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 |
$2,214.45
|
| Rate for Payer: Cash Price |
$2,214.45
|
| Rate for Payer: Cash Price |
$2,214.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,198.65
|
| 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 |
$3,046.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$260.97
|
| 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 |
$890.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.25
|
| 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 |
$3,690.75
|
| 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 RMVL CVA OBSTRUC INTRALUMINA
|
Facility
IP
|
$4,921.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$890.70 |
| Max. Negotiated Rate |
$3,690.75 |
| Rate for Payer: Adventist Health Commercial |
$984.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,380.73
|
| Rate for Payer: Cash Price |
$2,214.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,331.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,331.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,230.25
|
| Rate for Payer: Multiplan Commercial |
$3,690.75
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| 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 |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| 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 |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| 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 |
$84.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| 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 |
$131.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$63.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$58.47
|
| 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 RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$279.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
IP
|
$989.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$741.75 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$679.44
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$669.55
|
| Rate for Payer: Heritage Provider Network Senior |
$669.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.25
|
| Rate for Payer: Multiplan Commercial |
$741.75
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
OP
|
$989.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$197.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$679.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cash Price |
$445.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$642.85
|
| 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 |
$642.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$669.55
|
| Rate for Payer: Heritage Provider Network Senior |
$669.55
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$476.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.25
|
| 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 |
$741.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$359.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$330.42
|
| 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 RMVL FB CORNEA WO SLIT LAMP
|
Facility
OP
|
$773.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.17 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$80.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$502.45
|
| 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 |
$502.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$523.32
|
| Rate for Payer: Heritage Provider Network Senior |
$523.32
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.25
|
| 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 |
$579.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$280.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.26
|
| 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 RMVL FB CORNEA WO SLIT LAMP
|
Facility
IP
|
$773.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.91 |
| Max. Negotiated Rate |
$579.75 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.05
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$523.32
|
| Rate for Payer: Heritage Provider Network Senior |
$523.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.25
|
| Rate for Payer: Multiplan Commercial |
$579.75
|
|
