|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$311.25 |
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.10
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.96
|
| Rate for Payer: Heritage Provider Network Senior |
$280.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.75
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$81.46
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.52
|
| Rate for Payer: Heritage Provider Network Senior |
$36.52
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$68.02 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.02
|
| Rate for Payer: Blue Shield of California Commercial |
$63.84
|
| Rate for Payer: Blue Shield of California EPN |
$49.91
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$8.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.83
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.62
|
| Rate for Payer: Heritage Provider Network Senior |
$149.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.90
|
| Rate for Payer: Blue Shield of California Commercial |
$52.15
|
| Rate for Payer: Blue Shield of California EPN |
$40.77
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Senior |
$16.09
|
| Rate for Payer: Humana Medicare |
$6.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$98.24
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$96.81
|
| Rate for Payer: Heritage Provider Network Senior |
$96.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.75
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$100.56 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.51
|
| Rate for Payer: Blue Shield of California Commercial |
$100.56
|
| Rate for Payer: Blue Shield of California EPN |
$78.62
|
| 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 |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.92 |
| Max. Negotiated Rate |
$405.75 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.67
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.26
|
| Rate for Payer: Heritage Provider Network Senior |
$366.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.25
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$405.75 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.49
|
| Rate for Payer: Blue Shield of California Commercial |
$137.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.91
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.88
|
| Rate for Payer: Heritage Provider Network Senior |
$334.88
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ACTH
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Adventist Health Commercial |
$113.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$390.22
|
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$384.54
|
| Rate for Payer: Heritage Provider Network Senior |
$384.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
|
|
HC ACTH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$323.29 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.29
|
| Rate for Payer: Blue Shield of California Commercial |
$301.69
|
| Rate for Payer: Blue Shield of California EPN |
$235.85
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Senior |
$38.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.61
|
| Rate for Payer: Heritage Provider Network Senior |
$91.61
|
| Rate for Payer: Humana Medicare |
$38.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.66
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.62
|
| Rate for Payer: TriValley Medical Group Senior |
$38.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.32
|
| Rate for Payer: Heritage Provider Network Senior |
$152.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.61
|
| Rate for Payer: Blue Shield of California Commercial |
$33.26
|
| Rate for Payer: Blue Shield of California EPN |
$26.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Senior |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Humana Medicare |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$703.50 |
| Rate for Payer: Adventist Health Commercial |
$187.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$644.41
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$177.56
|
| Rate for Payer: Blue Shield of California Commercial |
$152.15
|
| Rate for Payer: Blue Shield of California EPN |
$86.52
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$609.70
|
| 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 |
$609.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.62
|
| Rate for Payer: Heritage Provider Network Senior |
$580.62
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.50
|
| 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 |
$169.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.50
|
| 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 |
$703.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| 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 ACUTE ABD SERIES
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.78 |
| Max. Negotiated Rate |
$703.50 |
| Rate for Payer: Adventist Health Commercial |
$187.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$644.41
|
| Rate for Payer: Cash Price |
$422.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$635.03
|
| Rate for Payer: Heritage Provider Network Senior |
$635.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.50
|
| Rate for Payer: Multiplan Commercial |
$703.50
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$167.79 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Adventist Health Commercial |
$185.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.85
|
| Rate for Payer: Cash Price |
$417.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.58
|
| Rate for Payer: Heritage Provider Network Senior |
$627.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$695.25
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$371.96 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$138.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.50
|
| Rate for Payer: Blue Shield of California Commercial |
$371.96
|
| Rate for Payer: Blue Shield of California EPN |
$290.78
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: Dignity Health Senior |
$47.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$47.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$47.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.01
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$47.63
|
| Rate for Payer: TriValley Medical Group Senior |
$47.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$51.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Senior |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
905601756
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$161.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Senior |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.41 |
| Max. Negotiated Rate |
$291.75 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$267.24
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$263.35
|
| Rate for Payer: Heritage Provider Network Senior |
$263.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.25
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.82
|
| Rate for Payer: Blue Shield of California Commercial |
$57.13
|
| Rate for Payer: Blue Shield of California EPN |
$54.00
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.20
|
| Rate for Payer: Dignity Health Senior |
$78.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$56.95
|
| Rate for Payer: Heritage Provider Network Senior |
$56.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78.20
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$193.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: Dignity Health Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$88.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Humana Medicare |
$88.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$167.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$110.91
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.82
|
| Rate for Payer: TriValley Medical Group Senior |
$88.02
|
| 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 |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
