|
HC DRUG SCREEN OPIATES
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN PHENCYCLIDINE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911147
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN PHENCYCLIDINE
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911147
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$90.75 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.13
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.92
|
| Rate for Payer: Heritage Provider Network Senior |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
|
|
HC DRUG SCREEN, PRE-EMPLOYMENT
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN, PRE-EMPLOYMENT
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$584.64
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.13
|
| Rate for Payer: Heritage Provider Network Senior |
$576.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.75
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
|
|
HC DRUGS OF ABUSE SCREEN,URINE(5)
|
Facility
|
IP
|
$608.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$110.05 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Adventist Health Commercial |
$121.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.70
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.62
|
| Rate for Payer: Heritage Provider Network Senior |
$411.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
|
|
HC DRUGS OF ABUSE SCREEN,URINE(5)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUGS OF ABUSE SCREEN,URINE(7)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.78
|
| Rate for Payer: Blue Shield of California Commercial |
$446.14
|
| Rate for Payer: Blue Shield of California EPN |
$348.77
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$118.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUGS OF ABUSE SCREEN,URINE(7)
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$154.03 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$584.64
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.13
|
| Rate for Payer: Heritage Provider Network Senior |
$576.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.75
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
|
|
HC DRVVT
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$80.07 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.07
|
| Rate for Payer: Blue Shield of California Commercial |
$74.74
|
| Rate for Payer: Blue Shield of California EPN |
$58.43
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Senior |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.90
|
| Rate for Payer: Heritage Provider Network Senior |
$22.90
|
| Rate for Payer: Humana Medicare |
$9.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DRVVT
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.08
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.91
|
| Rate for Payer: Heritage Provider Network Senior |
$146.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC DRVVT CONFIRM
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$142.21
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.14
|
| Rate for Payer: Heritage Provider Network Senior |
$140.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$155.25
|
|
|
HC DRVVT CONFIRM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
900912009
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$80.07 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.07
|
| Rate for Payer: Blue Shield of California Commercial |
$74.74
|
| Rate for Payer: Blue Shield of California EPN |
$58.43
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.54
|
| Rate for Payer: Dignity Health Senior |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.90
|
| Rate for Payer: Heritage Provider Network Senior |
$22.90
|
| Rate for Payer: Humana Medicare |
$9.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.58
|
| Rate for Payer: TriValley Medical Group Senior |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.54
|
| Rate for Payer: Vantage Medical Group Senior |
$9.58
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| 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 |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Senior |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC DSCHG RCP EDU TRAINING EA 30MN
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
900898960
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.58
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.64
|
| Rate for Payer: Heritage Provider Network Senior |
$63.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC D TEST
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.65
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| 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 |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC D TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.54
|
| Rate for Payer: Blue Shield of California Commercial |
$39.12
|
| Rate for Payer: Blue Shield of California EPN |
$36.98
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: Dignity Health Senior |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Senior |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.26 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$909.89
|
| Rate for Payer: Heritage Provider Network Senior |
$909.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$877.16
|
| Rate for Payer: Blue Shield of California Commercial |
$307.09
|
| Rate for Payer: Blue Shield of California EPN |
$174.64
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$873.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.94
|
| Rate for Payer: Heritage Provider Network Senior |
$831.94
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.26 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$909.89
|
| Rate for Payer: Heritage Provider Network Senior |
$909.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.34
|
| Rate for Payer: Blue Shield of California Commercial |
$115.75
|
| Rate for Payer: Blue Shield of California EPN |
$65.83
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$873.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.94
|
| Rate for Payer: Heritage Provider Network Senior |
$831.94
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$320.37 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$354.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.99
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,198.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.50
|
| Rate for Payer: Multiplan Commercial |
$1,327.50
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$354.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$642.15
|
| Rate for Payer: Blue Shield of California EPN |
$365.17
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,150.50
|
| 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 |
$1,150.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,095.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,095.63
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.36
|
| 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 |
$320.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.50
|
| 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 |
$1,327.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
