|
HC ESBL DISK CONFIRMATION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.17
|
| Rate for Payer: Heritage Provider Network Senior |
$142.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
|
|
HC ESBL DISK CONFIRMATION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912449
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$112.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$144.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.88
|
| Rate for Payer: Blue Shield of California Commercial |
$55.47
|
| Rate for Payer: Blue Shield of California EPN |
$44.49
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Senior |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC ESD INCL ENDSCPY OR CLNSCPY, MCSL CLSR
|
Facility
|
OP
|
$6,356.00
|
|
|
Service Code
|
CPT C9779
|
| Hospital Charge Code |
906749779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,184.68 |
| Rate for Payer: Adventist Health Commercial |
$1,271.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,366.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| 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 |
$3,495.80
|
| Rate for Payer: Cash Price |
$3,495.80
|
| Rate for Payer: Cash Price |
$3,495.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,131.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Senior |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,813.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,834.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,934.36
|
| Rate for Payer: Heritage Provider Network Senior |
$5,945.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,184.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,150.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,559.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,090.89
|
| Rate for Payer: Multiplan Commercial |
$4,767.00
|
| Rate for Payer: Multiplan WC |
$7,702.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,317.44
|
| Rate for Payer: TriValley Medical Group Senior |
$5,317.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ESD INCL ENDSCPY OR CLNSCPY, MCSL CLSR
|
Facility
|
IP
|
$6,356.00
|
|
|
Service Code
|
CPT C9779
|
| Hospital Charge Code |
906749779
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,150.44 |
| Max. Negotiated Rate |
$4,767.00 |
| Rate for Payer: Adventist Health Commercial |
$1,271.20
|
| Rate for Payer: Cash Price |
$3,495.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,303.01
|
| Rate for Payer: Heritage Provider Network Senior |
$4,303.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,150.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$4,767.00
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$653.98
|
| Rate for Payer: Heritage Provider Network Senior |
$653.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
|
|
HC ESOPH ACID REFLX TEST
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 91034
|
| Hospital Charge Code |
906791033
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$193.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$516.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$663.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| 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 |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cash Price |
$531.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$627.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Senior |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$674.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.95
|
| Rate for Payer: Heritage Provider Network Senior |
$829.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$460.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.47
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| 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 |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
IP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$553.32 |
| Max. Negotiated Rate |
$2,292.75 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,069.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,069.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.25
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
|
|
HC ESOPHAG DIAG W BALLOON DILATION
|
Facility
|
OP
|
$3,057.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
909000188
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$611.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,100.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cash Price |
$1,681.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,987.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,892.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$289.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,579.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,292.75
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,651.35
|
| Rate for Payer: TriValley Medical Group Senior |
$2,651.35
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,220.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,220.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.75
|
| Rate for Payer: Multiplan Commercial |
$1,352.25
|
|
|
HC ESOPHAGEAL DILATATION
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 74360
|
| Hospital Charge Code |
909001829
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.55 |
| Max. Negotiated Rate |
$1,532.55 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$963.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,238.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,532.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$991.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,352.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.13
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: Cash Price |
$991.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,171.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,532.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,532.55
|
| Rate for Payer: Dignity Health Senior |
$1,532.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,171.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,116.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$860.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,262.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,262.10
|
| Rate for Payer: Multiplan Commercial |
$1,352.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$901.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$901.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,532.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,532.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,532.55
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
OP
|
$6,570.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$148.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,511.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,513.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,584.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,613.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,927.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$3,613.50
|
| Rate for Payer: Cash Price |
$3,613.50
|
| Rate for Payer: Cash Price |
$3,613.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,270.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,584.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,584.50
|
| Rate for Payer: Dignity Health Senior |
$5,584.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,066.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4,066.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,133.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,189.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,642.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,599.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,599.00
|
| Rate for Payer: Multiplan Commercial |
$4,927.50
|
| 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 |
$5,584.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,584.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,584.50
|
|
|
HC ESOPHAGOGASTRIC TMPONAD W/BLLN
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
CPT 43460
|
| Hospital Charge Code |
906743460
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,189.17 |
| Max. Negotiated Rate |
$4,927.50 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Cash Price |
$3,613.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,447.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,189.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,642.50
|
| Rate for Payer: Multiplan Commercial |
$4,927.50
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
IP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,124.03 |
| Max. Negotiated Rate |
$8,801.25 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,944.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7,944.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,124.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,933.75
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
|
|
HC ESOPHAGOSCOPY RIGID TRANSORAL
|
Facility
|
OP
|
$11,735.00
|
|
|
Service Code
|
CPT 43180
|
| Hospital Charge Code |
906743180
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,274.66 |
| Rate for Payer: Adventist Health Commercial |
$2,347.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,061.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| 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 |
$6,454.25
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Cash Price |
$6,454.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,627.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Senior |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,516.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,263.97
|
| Rate for Payer: Heritage Provider Network Senior |
$9,245.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$787.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,597.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,124.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,643.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,933.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,470.71
|
| Rate for Payer: Multiplan Commercial |
$8,801.25
|
| 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 |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
OP
|
$3,352.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$670.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,302.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,843.60
|
| Rate for Payer: Cash Price |
$1,843.60
|
| Rate for Payer: Cash Price |
$1,843.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,178.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,269.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,269.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,598.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$2,514.00
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,206.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,109.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAGOSCOPY W BLLN LT 30MM
|
Facility
|
IP
|
$3,352.00
|
|
|
Service Code
|
CPT 43220
|
| Hospital Charge Code |
900501292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$2,514.00 |
| Rate for Payer: Adventist Health Commercial |
$670.40
|
| Rate for Payer: Cash Price |
$1,843.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,269.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,269.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$838.00
|
| Rate for Payer: Multiplan Commercial |
$2,514.00
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$369.42 |
| Max. Negotiated Rate |
$1,530.75 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,381.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,381.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.25
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
|
|
HC ESOPHAGOSCOPY W OPTICAL ENDOMI
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 43206
|
| Hospital Charge Code |
906743206
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,402.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Cash Price |
$1,122.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,326.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,263.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$973.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,368.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,313.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,189.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,280.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,280.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,211.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,115.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$3,368.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.61 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,280.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.00
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
IP
|
$3,368.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$609.61 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,280.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.00
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
|
|
HC ESOPHAGOSCOPY W/WO SPECIMEN
|
Facility
|
OP
|
$3,368.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
906743200
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,313.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$1,852.40
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Cash Price |
$1,852.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,189.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,084.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,606.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
IP
|
$5,727.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,036.59 |
| Max. Negotiated Rate |
$4,295.25 |
| Rate for Payer: Adventist Health Commercial |
$1,145.40
|
| Rate for Payer: Cash Price |
$3,149.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,877.18
|
| Rate for Payer: Heritage Provider Network Senior |
$3,877.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.75
|
| Rate for Payer: Multiplan Commercial |
$4,295.25
|
|
|
HC ESOPHAGUS CELLVIZIO
|
Facility
|
OP
|
$5,727.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906743499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,934.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$3,149.85
|
| Rate for Payer: Cash Price |
$3,149.85
|
| Rate for Payer: Cash Price |
$3,149.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,722.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,545.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,731.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,036.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$4,295.25
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ESOPHAGUS ENDOSCOPY W RMVL FB
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
CPT 43215
|
| Hospital Charge Code |
900501291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$389.15 |
| Max. Negotiated Rate |
$1,612.50 |
| Rate for Payer: Adventist Health Commercial |
$430.00
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,455.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,455.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.50
|
| Rate for Payer: Multiplan Commercial |
$1,612.50
|
|
