|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900400028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.43
|
| Rate for Payer: Heritage Provider Network Senior |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$17.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.70
|
| Rate for Payer: Dignity Health Senior |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.00
|
| Rate for Payer: Heritage Provider Network Senior |
$26.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.70
|
| Rate for Payer: Vantage Medical Group Senior |
$35.70
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$43.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.65
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.61
|
| Rate for Payer: Heritage Provider Network Senior |
$156.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$139.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
|
OP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$889.74 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$559.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.06
|
| Rate for Payer: Blue Shield of California Commercial |
$638.52
|
| Rate for Payer: Blue Shield of California EPN |
$510.81
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.74
|
| Rate for Payer: Dignity Health Senior |
$889.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$732.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$732.73
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$418.70
|
| Rate for Payer: TriValley Medical Group Senior |
$418.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.74
|
| Rate for Payer: Vantage Medical Group Senior |
$889.74
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
|
IP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
|
OP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$777.11 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$488.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$685.69
|
| Rate for Payer: Blue Shield of California Commercial |
$557.69
|
| Rate for Payer: Blue Shield of California EPN |
$446.15
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$777.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$777.11
|
| Rate for Payer: Dignity Health Senior |
$777.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.98
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$365.70
|
| Rate for Payer: TriValley Medical Group Senior |
$365.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$777.11
|
| Rate for Payer: Vantage Medical Group Senior |
$777.11
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
|
IP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
|
IP
|
$736.92
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$552.69 |
| Rate for Payer: Adventist Health Commercial |
$147.38
|
| Rate for Payer: Cash Price |
$405.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.19
|
| Rate for Payer: Heritage Provider Network Senior |
$341.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.23
|
| Rate for Payer: Multiplan Commercial |
$552.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.99
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
|
OP
|
$736.92
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$626.38 |
| Rate for Payer: Adventist Health Commercial |
$147.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$393.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.69
|
| Rate for Payer: Blue Shield of California Commercial |
$449.52
|
| Rate for Payer: Blue Shield of California EPN |
$359.62
|
| Rate for Payer: Cash Price |
$405.31
|
| Rate for Payer: Cash Price |
$405.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.38
|
| Rate for Payer: Dignity Health Senior |
$626.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.19
|
| Rate for Payer: Heritage Provider Network Senior |
$341.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.84
|
| Rate for Payer: Multiplan Commercial |
$552.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.77
|
| Rate for Payer: TriValley Medical Group Senior |
$294.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.38
|
| Rate for Payer: Vantage Medical Group Senior |
$626.38
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
|
IP
|
$573.50
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$430.12 |
| Rate for Payer: Adventist Health Commercial |
$114.70
|
| Rate for Payer: Cash Price |
$315.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.53
|
| Rate for Payer: Heritage Provider Network Senior |
$265.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.38
|
| Rate for Payer: Multiplan Commercial |
$430.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.89
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
|
OP
|
$573.50
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$487.48 |
| Rate for Payer: Adventist Health Commercial |
$114.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$306.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.12
|
| Rate for Payer: Blue Shield of California Commercial |
$349.83
|
| Rate for Payer: Blue Shield of California EPN |
$279.87
|
| Rate for Payer: Cash Price |
$315.42
|
| Rate for Payer: Cash Price |
$315.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.48
|
| Rate for Payer: Dignity Health Senior |
$487.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.53
|
| Rate for Payer: Heritage Provider Network Senior |
$265.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$273.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.45
|
| Rate for Payer: Multiplan Commercial |
$430.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.40
|
| Rate for Payer: TriValley Medical Group Senior |
$229.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.48
|
| Rate for Payer: Vantage Medical Group Senior |
$487.48
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
|
OP
|
$460.96
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$391.82 |
| Rate for Payer: Adventist Health Commercial |
$92.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$246.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.72
|
| Rate for Payer: Blue Shield of California Commercial |
$281.19
|
| Rate for Payer: Blue Shield of California EPN |
$224.95
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.82
|
| Rate for Payer: Dignity Health Senior |
$391.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.42
|
| Rate for Payer: Heritage Provider Network Senior |
$213.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$219.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.67
|
| Rate for Payer: Multiplan Commercial |
$345.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$184.38
|
| Rate for Payer: TriValley Medical Group Senior |
$184.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$166.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.82
|
| Rate for Payer: Vantage Medical Group Senior |
$391.82
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
|
IP
|
$460.96
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$345.72 |
| Rate for Payer: Adventist Health Commercial |
$92.19
|
| Rate for Payer: Cash Price |
$253.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.42
|
| Rate for Payer: Heritage Provider Network Senior |
$213.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.24
|
| Rate for Payer: Multiplan Commercial |
$345.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$166.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.62
|
|
|
HC CORD NEOX RT 2.0X1.0CM
|
Facility
|
OP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$889.74 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$559.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.06
|
| Rate for Payer: Blue Shield of California Commercial |
$638.52
|
| Rate for Payer: Blue Shield of California EPN |
$510.81
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.74
|
| Rate for Payer: Dignity Health Senior |
$889.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$732.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$732.73
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$418.70
|
| Rate for Payer: TriValley Medical Group Senior |
$418.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.74
|
| Rate for Payer: Vantage Medical Group Senior |
$889.74
|
|
|
HC CORD NEOX RT 2.0X1.0CM
|
Facility
|
IP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Cash Price |
$575.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
OP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$777.11 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$488.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$685.69
|
| Rate for Payer: Blue Shield of California Commercial |
$557.69
|
| Rate for Payer: Blue Shield of California EPN |
$446.15
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$777.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$777.11
|
| Rate for Payer: Dignity Health Senior |
$777.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$128.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.98
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$365.70
|
| Rate for Payer: TriValley Medical Group Senior |
$365.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$777.11
|
| Rate for Payer: Vantage Medical Group Senior |
$777.11
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
IP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Cash Price |
$502.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
|
