|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$143.92
|
| Rate for Payer: Blue Shield of California EPN |
$143.92
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cash Price |
$196.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Senior |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Senior |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.60
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$129.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$118.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,362.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,250.00
|
| Rate for Payer: Blue Shield of California EPN |
$12,200.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,475.00
|
| Rate for Payer: Heritage Provider Network Senior |
$15,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11,925.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,500.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,500.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12,500.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16,925.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,224.05 |
| Max. Negotiated Rate |
$25,790.25 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,280.00
|
| Rate for Payer: Heritage Provider Network Senior |
$23,280.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,596.75
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$34,387.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$6,877.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,623.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Cash Price |
$18,912.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,351.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,632.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,285.55
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,224.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,596.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$25,790.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$140.70
|
| Rate for Payer: Blue Shield of California EPN |
$140.70
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.05
|
| Rate for Payer: Heritage Provider Network Senior |
$162.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$126.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.89
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$140.70
|
| Rate for Payer: Blue Shield of California EPN |
$140.70
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.05
|
| Rate for Payer: Heritage Provider Network Senior |
$162.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$126.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$115.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,298.12 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,977.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,350.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,021.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,682.47
|
| Rate for Payer: Blue Shield of California EPN |
$2,145.98
|
| Rate for Payer: Cash Price |
$2,418.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,858.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Senior |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,858.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,722.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,722.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,097.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,078.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,078.25
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,198.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,198.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$538.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$451.20
|
| Rate for Payer: Blue Shield of California EPN |
$451.20
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.67
|
| Rate for Payer: Heritage Provider Network Senior |
$519.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.63
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$538.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$771.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$451.20
|
| Rate for Payer: Blue Shield of California EPN |
$451.20
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cash Price |
$617.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Senior |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.67
|
| Rate for Payer: Heritage Provider Network Senior |
$519.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.68
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$371.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,861.00 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,418.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,539.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,281.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$7,539.95
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,910.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,652.65
|
| Rate for Payer: Dignity Health Senior |
$11,652.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,225.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,485.87
|
| Rate for Payer: Heritage Provider Network Senior |
$8,485.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,352.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,539.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,481.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,427.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,596.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,596.30
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,652.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,652.65
|
| Rate for Payer: Vantage Medical Group Senior |
$11,652.65
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$13,709.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,481.33 |
| Max. Negotiated Rate |
$10,281.75 |
| Rate for Payer: Adventist Health Commercial |
$2,741.80
|
| Rate for Payer: Cash Price |
$7,539.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,280.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9,280.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,481.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,427.25
|
| Rate for Payer: Multiplan Commercial |
$10,281.75
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,169.62 |
| Max. Negotiated Rate |
$4,846.50 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,374.77
|
| Rate for Payer: Heritage Provider Network Senior |
$4,374.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,439.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,554.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,200.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,492.70
|
| Rate for Payer: Dignity Health Senior |
$5,492.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,999.98
|
| Rate for Payer: Heritage Provider Network Senior |
$3,999.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,082.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,169.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,523.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,523.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,492.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,492.70
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Senior |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,106.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$758.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,272.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,394.01
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$572.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
900501170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Cash Price |
$874.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
OP
|
$2,512.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,725.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,554.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$197.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,198.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC ENDO EVAL SM INTESTINE W BX
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 44386
|
| Hospital Charge Code |
906744386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$454.67 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,700.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
IP
|
$2,512.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$454.67 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,700.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,700.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
|
|
HC ENDO EVAL SM INTESTINE W WO COLLECT
|
Facility
|
OP
|
$2,512.00
|
|
|
Service Code
|
CPT 44385
|
| Hospital Charge Code |
906744385
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$502.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,725.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,554.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,198.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,884.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Senior |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$458.06
|
| Rate for Payer: Heritage Provider Network Senior |
$458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$352.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Senior |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$352.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC ENDOLUMINAL BRUSHING
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
909081376
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.98
|
| Rate for Payer: Heritage Provider Network Senior |
$500.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
|
