|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$3,763.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$752.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,325.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,693.35
|
| Rate for Payer: Cash Price |
$1,693.35
|
| Rate for Payer: Cash Price |
$1,693.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,445.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,329.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$681.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,822.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
IP
|
$3,763.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$2,822.25 |
| Rate for Payer: Adventist Health Commercial |
$752.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,423.37
|
| Rate for Payer: Cash Price |
$1,693.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,547.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,547.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$681.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.75
|
| Rate for Payer: Multiplan Commercial |
$2,822.25
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,110.25 |
| Max. Negotiated Rate |
$12,185.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,790.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,373.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,600.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,213.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,213.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,796.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,796.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,925.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,110.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,293.80
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,213.90
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,110.25 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,950.30
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Cash Price |
$2,760.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,110.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.50
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$18,264.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,305.78 |
| Max. Negotiated Rate |
$13,698.00 |
| Rate for Payer: Adventist Health Commercial |
$3,652.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,762.02
|
| Rate for Payer: Cash Price |
$8,218.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,364.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,364.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,305.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,566.00
|
| Rate for Payer: Multiplan Commercial |
$13,698.00
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$18,264.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,305.78 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$3,652.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,287.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,675.40
|
| Rate for Payer: Blue Shield of California EPN |
$6,903.79
|
| Rate for Payer: Cash Price |
$8,218.80
|
| Rate for Payer: Cash Price |
$8,218.80
|
| Rate for Payer: Cash Price |
$8,218.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,871.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,364.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,364.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,711.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,305.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,566.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$13,698.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,958.40
|
| Rate for Payer: TriValley Medical Group Senior |
$10,958.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,773.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$4,329.75 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,717.81
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,044.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,773.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$5,158.00 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,567.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,742.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,182.19
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,752.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,752.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,753.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,044.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,463.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,463.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,511.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.17
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,068.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,909.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,909.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$2,387.25 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,049.85
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$696.35
|
| Rate for Payer: Blue Shield of California EPN |
$554.15
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$395.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$699.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.34
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$879.60
|
| Rate for Payer: TriValley Medical Group Senior |
$879.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Vantage Medical Group Senior |
$395.03
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$1,099.50 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$944.10
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$265.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$352.45
|
| Rate for Payer: Blue Shield of California EPN |
$280.48
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Senior |
$445.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$477.85
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$352.45
|
| Rate for Payer: Blue Shield of California EPN |
$280.48
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$445.20
|
| Rate for Payer: TriValley Medical Group Senior |
$445.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$156.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$482.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$370.98
|
| Rate for Payer: Blue Shield of California EPN |
$295.22
|
| Rate for Payer: Cash Price |
$351.45
|
| Rate for Payer: Cash Price |
$351.45
|
| Rate for Payer: Cash Price |
$351.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$507.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.74
|
| Rate for Payer: Heritage Provider Network Senior |
$528.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$372.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$585.75
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$468.60
|
| Rate for Payer: TriValley Medical Group Senior |
$468.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$585.75 |
| Rate for Payer: Adventist Health Commercial |
$156.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$502.96
|
| Rate for Payer: Cash Price |
$351.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.74
|
| Rate for Payer: Heritage Provider Network Senior |
$528.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.25
|
| Rate for Payer: Multiplan Commercial |
$585.75
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,547.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,781.70
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,415.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,415.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,739.20
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
OP
|
$14,773.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$12,557.05 |
| Rate for Payer: Adventist Health Commercial |
$2,954.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,129.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,125.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,079.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,647.85
|
| Rate for Payer: Cash Price |
$6,647.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,602.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,557.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,557.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,144.49
|
| Rate for Payer: Heritage Provider Network Senior |
$9,144.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,046.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,673.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,693.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,341.10
|
| Rate for Payer: Multiplan Commercial |
$11,079.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,557.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12,557.05
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
IP
|
$14,773.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,673.91 |
| Max. Negotiated Rate |
$11,079.75 |
| Rate for Payer: Adventist Health Commercial |
$2,954.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,513.81
|
| Rate for Payer: Cash Price |
$6,647.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,001.32
|
| Rate for Payer: Heritage Provider Network Senior |
$10,001.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,673.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,693.25
|
| Rate for Payer: Multiplan Commercial |
$11,079.75
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$252.45
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$821.55 |
| Rate for Payer: Adventist Health Commercial |
$66.80
|
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.97
|
| Rate for Payer: Blue Shield of California Commercial |
$821.55
|
| Rate for Payer: Blue Shield of California Commercial |
$821.55
|
| Rate for Payer: Blue Shield of California EPN |
$658.95
|
| Rate for Payer: Blue Shield of California EPN |
$658.95
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$142.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$142.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$206.75
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$142.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$142.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$159.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$186.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.12
|
| Rate for Payer: Multiplan Commercial |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.63
|
| Rate for Payer: TriValley Medical Group Senior |
$142.63
|
| Rate for Payer: TriValley Medical Group Senior |
$142.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Vantage Medical Group Senior |
$142.63
|
| Rate for Payer: Vantage Medical Group Senior |
$142.63
|
|
|
HC RESPIRATORY PANEL, NUCLEIC ACID
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900913642
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.74 |
| Max. Negotiated Rate |
$1,155.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$991.76
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,042.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,042.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$278.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.00
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
|
