|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,523.86 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,579.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,669.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,458.00
|
| 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 |
$7,669.20
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,852.40
|
| Rate for Payer: Dignity Health Senior |
$11,852.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,366.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,631.34
|
| Rate for Payer: Heritage Provider Network Senior |
$8,631.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,651.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,760.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,972.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,852.40
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$828.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,064.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.06
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,007.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$959.45
|
| Rate for Payer: Heritage Provider Network Senior |
$959.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$739.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$696.67
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.93 |
| Max. Negotiated Rate |
$1,234.50 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,114.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,114.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$1,234.50 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$879.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,130.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,069.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,018.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,018.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$785.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$696.67
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$680.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$680.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.55 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,049.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,505.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,337.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,069.70
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,424.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,356.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,356.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,045.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$855.55
|
| Rate for Payer: TriValley Medical Group Senior |
$855.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,096.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.75 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Adventist Health Commercial |
$438.40
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,483.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,483.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$821.25 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$741.32
|
| Rate for Payer: Heritage Provider Network Senior |
$741.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$752.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$667.95
|
| Rate for Payer: Blue Shield of California EPN |
$534.36
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cash Price |
$602.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$711.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Senior |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.80
|
| Rate for Payer: Heritage Provider Network Senior |
$677.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$522.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$547.50
|
| Rate for Payer: TriValley Medical Group Senior |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$547.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
OP
|
$4,407.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$881.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,027.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,688.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,150.62
|
| Rate for Payer: Cash Price |
$2,423.85
|
| Rate for Payer: Cash Price |
$2,423.85
|
| Rate for Payer: Cash Price |
$2,423.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,864.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,727.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,727.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,102.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$3,305.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,556.64
|
| Rate for Payer: TriValley Medical Group Senior |
$2,556.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,203.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,203.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
|
IP
|
$4,407.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$797.67 |
| Max. Negotiated Rate |
$3,305.25 |
| Rate for Payer: Adventist Health Commercial |
$881.40
|
| Rate for Payer: Cash Price |
$2,423.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,983.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,983.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.75
|
| Rate for Payer: Multiplan Commercial |
$3,305.25
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.62 |
| Max. Negotiated Rate |
$2,683.50 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,422.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,422.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,458.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,182.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,746.06
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,325.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Senior |
$3,041.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,214.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,214.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,706.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,504.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,789.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,789.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.92
|
| Rate for Payer: Blue Shield of California Commercial |
$69.58
|
| Rate for Payer: Blue Shield of California EPN |
$55.81
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.61
|
| Rate for Payer: Heritage Provider Network Senior |
$65.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.90
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.65
|
| Rate for Payer: TriValley Medical Group Senior |
$8.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$134.40
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.94
|
| Rate for Payer: Heritage Provider Network Senior |
$454.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
|
|
HC SUTR RMVL UNDER ANES SAME PHYS
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
CPT 15850
|
| Hospital Charge Code |
907201032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$359.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$461.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$504.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$436.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$571.20
|
| Rate for Payer: Dignity Health Senior |
$571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$454.94
|
| Rate for Payer: Heritage Provider Network Senior |
$454.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$320.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$470.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$470.40
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$241.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$222.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$571.20
|
| Rate for Payer: Vantage Medical Group Senior |
$571.20
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$574.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$459.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$543.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$710.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$710.60
|
| Rate for Payer: Dignity Health Senior |
$710.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.97
|
| Rate for Payer: Heritage Provider Network Senior |
$565.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$585.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$300.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$276.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$710.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Vantage Medical Group Senior |
$710.60
|
|
|
HC SUTR/STPL RMVL NOT REQUIRING ANES
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
907205853
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Adventist Health Commercial |
$167.20
|
| Rate for Payer: Cash Price |
$459.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.97
|
| Rate for Payer: Heritage Provider Network Senior |
$565.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$627.00
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC SUTURE EYELID, FULL THICKNESS
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 67935
|
| Hospital Charge Code |
900501309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,352.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Senior |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,734.97
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,755.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,615.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC SUTURE EYELID,PARTIAL THICKNES
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
900501413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,352.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Senior |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,734.97
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,755.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,615.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
OP
|
$9,136.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Adventist Health Commercial |
$1,827.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,276.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,938.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,938.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,185.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,185.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,357.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,653.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$6,852.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,287.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,024.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC SUTURE HAND/FOOT 1 DIGIT NERVE
|
Facility
|
IP
|
$9,136.00
|
|
|
Service Code
|
CPT 64831
|
| Hospital Charge Code |
900501398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,653.62 |
| Max. Negotiated Rate |
$6,852.00 |
| Rate for Payer: Adventist Health Commercial |
$1,827.20
|
| Rate for Payer: Cash Price |
$5,024.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,185.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,185.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,653.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,284.00
|
| Rate for Payer: Multiplan Commercial |
$6,852.00
|
|
