|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$255.57 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.04
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.92
|
| Rate for Payer: Heritage Provider Network Senior |
$955.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.00
|
| Rate for Payer: Multiplan Commercial |
$1,059.00
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,391.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,262.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,610.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH BOUGIE/SNGL OR MUL
|
Facility
|
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
906743450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$630.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,391.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,262.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,356.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,356.64
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,677.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,610.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,263.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,163.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
OP
|
$3,475.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$156.81 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$695.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,387.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,258.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,151.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$156.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,606.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC DILAT ESOPH OVER GUIDE WIRE
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 43453
|
| Hospital Charge Code |
906743453
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$255.57 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Adventist Health Commercial |
$282.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.04
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.92
|
| Rate for Payer: Heritage Provider Network Senior |
$955.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.00
|
| Rate for Payer: Multiplan Commercial |
$1,059.00
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$206.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: Dignity Health Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$497.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.90
|
| Rate for Payer: Humana Medicare |
$497.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.25
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$170.38
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.90
|
| Rate for Payer: Heritage Provider Network Senior |
$167.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$4,015.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$3,011.25 |
| Rate for Payer: Adventist Health Commercial |
$803.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,758.30
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,718.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,718.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.75
|
| Rate for Payer: Multiplan Commercial |
$3,011.25
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$4,015.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$803.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,758.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cash Price |
$1,806.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,609.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,718.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,718.16
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,935.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$3,011.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,457.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,341.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Blue Shield of California Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California EPN |
$18.20
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Senior |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$4,986.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$902.47 |
| Max. Negotiated Rate |
$3,739.50 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,425.38
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,375.52
|
| Rate for Payer: Heritage Provider Network Senior |
$3,375.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,246.50
|
| Rate for Payer: Multiplan Commercial |
$3,739.50
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$7,526.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$164.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,505.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,170.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cash Price |
$3,386.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,891.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,658.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$164.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,362.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,881.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$5,644.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$9,193.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,663.93 |
| Max. Negotiated Rate |
$6,894.75 |
| Rate for Payer: Adventist Health Commercial |
$1,838.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,315.59
|
| Rate for Payer: Cash Price |
$4,136.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,223.66
|
| Rate for Payer: Heritage Provider Network Senior |
$6,223.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,663.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.25
|
| Rate for Payer: Multiplan Commercial |
$6,894.75
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$9,193.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$341.50 |
| Max. Negotiated Rate |
$14,131.19 |
| Rate for Payer: Adventist Health Commercial |
$1,838.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,315.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$4,136.85
|
| Rate for Payer: Cash Price |
$4,136.85
|
| Rate for Payer: Cash Price |
$4,136.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,975.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,690.47
|
| Rate for Payer: Heritage Provider Network Senior |
$5,357.54
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,663.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$6,894.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,791.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.70
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: Dignity Health Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$802.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Humana Medicare |
$802.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,011.19
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$882.78
|
| Rate for Payer: TriValley Medical Group Senior |
$882.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$116.53 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.70
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: Dignity Health Senior |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$397.50
|
| Rate for Payer: TriValley Medical Group Senior |
$397.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$596.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.70
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: Dignity Health Senior |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$397.50
|
| Rate for Payer: TriValley Medical Group Senior |
$397.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.70
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: Dignity Health Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$802.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Humana Medicare |
$802.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,011.19
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$882.78
|
| Rate for Payer: TriValley Medical Group Senior |
$882.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$538.22
|
| Rate for Payer: Heritage Provider Network Senior |
$538.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$143.90 |
| Max. Negotiated Rate |
$5,287.00 |
| Rate for Payer: Adventist Health Commercial |
$159.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$546.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,890.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.70
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: Dignity Health Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$802.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Humana Medicare |
$802.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,287.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,011.19
|
| Rate for Payer: Multiplan Commercial |
$596.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$882.78
|
| Rate for Payer: TriValley Medical Group Senior |
$882.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,882.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,267.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
