|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
IP
|
$2,729.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
906601143
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$493.95 |
| Max. Negotiated Rate |
$2,046.75 |
| Rate for Payer: Adventist Health Commercial |
$545.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,874.82
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,847.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,847.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.25
|
| Rate for Payer: Multiplan Commercial |
$2,046.75
|
|
|
HC TRANSCRANIAL DUPLEX/DOPPLER
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
906601144
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$269.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$149.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$926.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$585.02
|
| Rate for Payer: Blue Shield of California EPN |
$332.68
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cash Price |
$607.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$876.85
|
| 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 |
$876.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$835.03
|
| Rate for Payer: Heritage Provider Network Senior |
$835.03
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$203.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.25
|
| 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 |
$1,011.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| 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 TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$476.25 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.90
|
| Rate for Payer: Heritage Provider Network Senior |
$429.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
|
|
HC TRANSESOPHOGEAL CARDIAC OUTPUT
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
900800525
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$476.25 |
| Rate for Payer: Adventist Health Commercial |
$127.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$436.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$394.34
|
| Rate for Payer: Blue Shield of California EPN |
$372.74
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cash Price |
$285.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$393.06
|
| Rate for Payer: Heritage Provider Network Senior |
$393.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$476.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRANSFERRIN
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.00
|
| Rate for Payer: Blue Shield of California Commercial |
$99.73
|
| Rate for Payer: Blue Shield of California EPN |
$77.96
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Senior |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC TRANSFERRIN
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900910854
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,243.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Dignity Health Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$542.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Humana Medicare |
$542.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$922.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$639.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.93
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,243.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Dignity Health Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$542.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: Humana Medicare |
$542.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,030.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$596.62
|
| Rate for Payer: TriValley Medical Group Senior |
$542.38
|
| 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 |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,434.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
906536430
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,122.93
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,243.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Dignity Health Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$542.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Senior |
$1,184.15
|
| Rate for Payer: Humana Medicare |
$542.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,030.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$596.62
|
| Rate for Payer: TriValley Medical Group Senior |
$542.38
|
| 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 |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,434.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC TRANSFUS BLOOD/BLOOD COMPONENT
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
907201094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.25 |
| Max. Negotiated Rate |
$1,434.75 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,314.23
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,295.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,295.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.25
|
| Rate for Payer: Multiplan Commercial |
$1,434.75
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,093.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$542.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$988.01
|
| Rate for Payer: Blue Shield of California EPN |
$933.92
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,034.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.62
|
| Rate for Payer: Dignity Health Senior |
$542.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$542.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.83
|
| Rate for Payer: Heritage Provider Network Senior |
$984.83
|
| Rate for Payer: Humana Medicare |
$542.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$542.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,030.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$1,193.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$596.62
|
| Rate for Payer: TriValley Medical Group Senior |
$542.38
|
| 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 |
$813.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.62
|
| Rate for Payer: Vantage Medical Group Senior |
$542.38
|
|
|
HC TRANSFUS INTRAUTERINE FETUS
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 36460
|
| Hospital Charge Code |
910400021
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$287.97 |
| Max. Negotiated Rate |
$1,193.25 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,093.02
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,077.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.75
|
| Rate for Payer: Multiplan Commercial |
$1,193.25
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC TRANSGLUTAMINASE IGA AB
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913555
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC TRANSTHYRETIN
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$249.00 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$228.08
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.76
|
| Rate for Payer: Heritage Provider Network Senior |
$224.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
|
|
HC TRANSTHYRETIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
900910925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$122.45 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.45
|
| Rate for Payer: Blue Shield of California Commercial |
$113.92
|
| Rate for Payer: Blue Shield of California EPN |
$89.06
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.05
|
| Rate for Payer: Dignity Health Senior |
$14.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$14.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.59
|
| Rate for Payer: TriValley Medical Group Senior |
$14.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14.59
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.47 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$981.04
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$966.76
|
| Rate for Payer: Heritage Provider Network Senior |
$966.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
|
|
HC TREAT FOOT DISLOCATION W/ANEST
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
CPT 28605
|
| Hospital Charge Code |
902890262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$981.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$928.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$966.76
|
| Rate for Payer: Heritage Provider Network Senior |
$966.76
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$688.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$357.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$518.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$477.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
OP
|
$27,434.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$20,575.50 |
| Rate for Payer: Adventist Health Commercial |
$5,486.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,847.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$12,345.30
|
| Rate for Payer: Cash Price |
$12,345.30
|
| Rate for Payer: Cash Price |
$12,345.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,832.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,572.82
|
| Rate for Payer: Heritage Provider Network Senior |
$18,572.82
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,223.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,965.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,858.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$20,575.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,961.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,165.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC TREAT FX RADIUS & ULNA
|
Facility
|
IP
|
$27,434.00
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
900501765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,965.55 |
| Max. Negotiated Rate |
$20,575.50 |
| Rate for Payer: Adventist Health Commercial |
$5,486.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,847.16
|
| Rate for Payer: Cash Price |
$12,345.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,572.82
|
| Rate for Payer: Heritage Provider Network Senior |
$18,572.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,965.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,858.50
|
| Rate for Payer: Multiplan Commercial |
$20,575.50
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$714.48
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.08
|
| Rate for Payer: Heritage Provider Network Senior |
$704.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
|
|
HC TREAT HIP DISLOC W/O ANESTH/MA
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 27256
|
| Hospital Charge Code |
900501604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$714.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$676.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.08
|
| Rate for Payer: Heritage Provider Network Senior |
$704.08
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$501.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$377.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$347.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT HIP SOCKET FX
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
900501683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
