|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$655.14
|
| Rate for Payer: Blue Shield of California EPN |
$524.11
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$4,472.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$623.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,909.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,000.17
|
| Rate for Payer: TriValley Medical Group Senior |
$4,000.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$655.14
|
| Rate for Payer: Blue Shield of California EPN |
$524.11
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$512.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$751.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$751.80
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$537.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$537.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC DEBRIDEMENT BONE SKIN AND MUSCLE EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
900101493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$158.01
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.50
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| 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 |
$172.50
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$82.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.15
|
| 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 DEBRIDEMENT NAIL 1-5
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.71
|
| Rate for Payer: Heritage Provider Network Senior |
$155.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.50
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,183.40
|
| Rate for Payer: Blue Shield of California EPN |
$946.72
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,261.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,200.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,200.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$925.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$970.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$970.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,332.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,261.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$925.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$698.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$642.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.14 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Cash Price |
$1,067.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,313.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,313.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.20
|
| Rate for Payer: Blue Shield of California EPN |
$156.16
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$208.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Senior |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.08
|
| Rate for Payer: Heritage Provider Network Senior |
$198.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$160.00
|
| Rate for Payer: TriValley Medical Group Senior |
$160.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC DEBRIDE SKIN INFECT EA ADDL10%
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 11001
|
| Hospital Charge Code |
900101490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$459.33
|
| Rate for Payer: Blue Shield of California EPN |
$367.46
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.11
|
| Rate for Payer: Heritage Provider Network Senior |
$466.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$253.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$855.55
|
| Rate for Payer: TriValley Medical Group Senior |
$855.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$270.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$512.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$386.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$355.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Cash Price |
$590.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$270.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$459.33
|
| Rate for Payer: Blue Shield of California EPN |
$367.46
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.11
|
| Rate for Payer: Heritage Provider Network Senior |
$466.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$558.40
|
| Rate for Payer: TriValley Medical Group Senior |
$558.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$459.33
|
| Rate for Payer: Blue Shield of California EPN |
$367.46
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.11
|
| Rate for Payer: Heritage Provider Network Senior |
$466.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$558.40
|
| Rate for Payer: TriValley Medical Group Senior |
$507.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DEB SKIN & SUBQ TISSUE
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
900501012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$414.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC DEB SUBQ AND DERMIS TISSUE EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
900101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$460.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$502.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.70
|
| Rate for Payer: Blue Shield of California EPN |
$326.96
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cash Price |
$368.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$435.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$569.50
|
| Rate for Payer: Dignity Health Senior |
$569.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.73
|
| Rate for Payer: Heritage Provider Network Senior |
$414.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$319.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$469.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$469.00
|
| Rate for Payer: Multiplan Commercial |
$502.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.00
|
| Rate for Payer: TriValley Medical Group Senior |
$335.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$335.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$569.50
|
| Rate for Payer: Vantage Medical Group Senior |
$569.50
|
|
