|
HC BILIRUBIN ICTOTEST
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910181
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.94
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.45
|
| Rate for Payer: Heritage Provider Network Senior |
$51.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.19
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$58.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910273
|
|
Hospital Revenue Code
|
301
|
| 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 |
$60.54
|
| 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 Foundation Hospitals Medi-Cal |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.50
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC BILIRUBIN TOTAL CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900912177
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$47.49 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$32.43
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TOTAL INDIVIDUAL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
900910499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$47.56 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.56
|
| Rate for Payer: Blue Shield of California Commercial |
$42.22
|
| Rate for Payer: Blue Shield of California Commercial |
$42.22
|
| Rate for Payer: Blue Shield of California EPN |
$33.86
|
| Rate for Payer: Blue Shield of California EPN |
$33.86
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$93.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$89.14
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$68.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: TriValley Medical Group Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.52
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC BILIRUBIN TRANSCUTANEOUS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
900912154
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.74
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.49
|
| Rate for Payer: Heritage Provider Network Senior |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,213.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,104.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,241.01
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,041.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
HC BIL STNT PLCMNT NEW ACC W CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47540
|
| Hospital Charge Code |
909047540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,041.39 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,937.33
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,856.48
|
| Rate for Payer: Heritage Provider Network Senior |
$18,856.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,041.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
OP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,672.00 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,213.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,104.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,241.01
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,041.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
HC BIL STNT PLCMT NEW ACC WO CATH
|
Facility
|
IP
|
$27,853.00
|
|
|
Service Code
|
CPT 47539
|
| Hospital Charge Code |
909047539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,041.39 |
| Max. Negotiated Rate |
$20,889.75 |
| Rate for Payer: Adventist Health Commercial |
$5,570.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,937.33
|
| Rate for Payer: Cash Price |
$12,533.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,856.48
|
| Rate for Payer: Heritage Provider Network Senior |
$18,856.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,041.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,963.25
|
| Rate for Payer: Multiplan Commercial |
$20,889.75
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.05
|
| Rate for Payer: Blue Shield of California Commercial |
$146.40
|
| Rate for Payer: Blue Shield of California EPN |
$117.12
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.56
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: Vantage Medical Group Senior |
$204.00
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.54
|
| Rate for Payer: Blue Shield of California Commercial |
$132.37
|
| Rate for Payer: Blue Shield of California EPN |
$105.90
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.32
|
| Rate for Payer: Heritage Provider Network Senior |
$134.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| 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 |
$139.75
|
| 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 Foundation Hospitals Medi-Cal |
$39.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.25
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$471.00 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.52
|
| Rate for Payer: Blue Shield of California Commercial |
$53.07
|
| Rate for Payer: Blue Shield of California EPN |
$42.46
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.85
|
| Rate for Payer: Heritage Provider Network Senior |
$53.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.03
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.90
|
| Rate for Payer: Heritage Provider Network Senior |
$58.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.75
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,020.10
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,072.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$154.10 |
| Max. Negotiated Rate |
$1,346.40 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$871.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$792.32
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,029.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,346.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,346.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$934.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.50
|
| Rate for Payer: Heritage Provider Network Senior |
$980.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$755.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,346.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,346.40
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
IP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.70 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,020.10
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,072.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
OP
|
$1,584.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Adventist Health Commercial |
$316.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$792.32
|
| Rate for Payer: Blue Shield of California Commercial |
$341.66
|
| Rate for Payer: Blue Shield of California EPN |
$274.75
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,029.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$934.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.50
|
| Rate for Payer: Heritage Provider Network Senior |
$980.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$755.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$286.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
