|
HC D TEST
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.65
|
| Rate for Payer: Blue Shield of California Commercial |
$53.83
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| 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 |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$7.48
|
| Rate for Payer: IEHP Medi-Cal |
$6.60
|
| Rate for Payer: IEHP Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| 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 |
$23.25
|
| 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 D TEST
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912427
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$163.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.54
|
| Rate for Payer: Blue Shield of California Commercial |
$39.12
|
| Rate for Payer: Blue Shield of California EPN |
$36.98
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.55
|
| Rate for Payer: Dignity Health Senior |
$53.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Senior |
$39.00
|
| Rate for Payer: IEHP Medi-Cal |
$107.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Vantage Medical Group Senior |
$53.55
|
|
|
HC DT VACCINE IM LT 7 YRS
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
CPT 90702
|
| Hospital Charge Code |
900501449
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.28
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.65
|
| Rate for Payer: Heritage Provider Network Senior |
$42.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$47.25
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.26 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$909.89
|
| Rate for Payer: Heritage Provider Network Senior |
$909.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
|
|
HC DUCTOGRAM/ASPIRATION-2 OR MORE
|
Facility
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
909001446
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$154.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$877.16
|
| Rate for Payer: Blue Shield of California Commercial |
$307.09
|
| Rate for Payer: Blue Shield of California EPN |
$174.64
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$873.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.94
|
| Rate for Payer: Heritage Provider Network Senior |
$831.94
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$99.47
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$630.34
|
| Rate for Payer: Blue Shield of California Commercial |
$115.75
|
| Rate for Payer: Blue Shield of California EPN |
$65.83
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$873.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.94
|
| Rate for Payer: Heritage Provider Network Senior |
$831.94
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$76.94
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUCTOGRAM/ASPIRATION- SINGLE
|
Facility
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
909001433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.26 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Commercial |
$268.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$923.33
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$909.89
|
| Rate for Payer: Heritage Provider Network Senior |
$909.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$354.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$642.15
|
| Rate for Payer: Blue Shield of California EPN |
$365.17
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,150.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,095.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,095.63
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$241.36
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,327.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLEX ABD PELVIS SCROTAL CONTENTS AND OR RETROPERI ORGANS LIMITED
|
Facility
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
906601559
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$320.37 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Adventist Health Commercial |
$354.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,215.99
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,198.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.50
|
| Rate for Payer: Multiplan Commercial |
$1,327.50
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
IP
|
$1,931.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$349.51 |
| Max. Negotiated Rate |
$1,448.25 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,326.60
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
|
|
HC DUPLEX SCAN AORTA/VENA CAVA
|
Facility
OP
|
$1,931.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
906601159
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$256.07 |
| Max. Negotiated Rate |
$1,448.25 |
| Rate for Payer: Adventist Health Commercial |
$386.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,326.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$710.84
|
| Rate for Payer: Blue Shield of California EPN |
$404.23
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cash Price |
$868.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,255.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,255.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,195.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,195.29
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$256.07
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,448.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$262.45 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$789.54
|
| Rate for Payer: Blue Shield of California EPN |
$448.99
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,033.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.21
|
| Rate for Payer: Heritage Provider Network Senior |
$984.21
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$262.45
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX EXT VEIN BILAT
|
Facility
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
908100110
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,092.33
|
| Rate for Payer: Cash Price |
$715.50
|
| 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 DUPLX EXT VEIN UNILAT
|
Facility
OP
|
$1,713.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$131.91 |
| Max. Negotiated Rate |
$1,284.75 |
| Rate for Payer: Adventist Health Commercial |
$342.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,176.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$569.31
|
| Rate for Payer: Blue Shield of California EPN |
$323.75
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,113.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,113.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,060.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,060.35
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$131.91
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,284.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX EXT VEIN UNILAT
|
Facility
IP
|
$1,713.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
908100124
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$310.05 |
| Max. Negotiated Rate |
$1,284.75 |
| Rate for Payer: Adventist Health Commercial |
$342.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,176.83
|
| Rate for Payer: Cash Price |
$770.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,159.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,159.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.25
|
| Rate for Payer: Multiplan Commercial |
$1,284.75
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
IP
|
$2,600.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$470.60 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Adventist Health Commercial |
$520.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.20
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,760.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,760.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.00
|
| Rate for Payer: Multiplan Commercial |
$1,950.00
|
|
|
HC DUPLX LO EXT ARTERY BILAT
|
Facility
OP
|
$2,600.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
908100106
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.12 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Adventist Health Commercial |
$520.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,786.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$964.90
|
| Rate for Payer: Blue Shield of California EPN |
$548.71
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,690.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,690.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,609.40
|
| Rate for Payer: Heritage Provider Network Senior |
$1,609.40
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$151.12
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$650.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,950.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$129.26 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$244.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$232.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$565.12
|
| Rate for Payer: Blue Shield of California EPN |
$321.37
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$793.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$793.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$755.18
|
| Rate for Payer: Heritage Provider Network Senior |
$755.18
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$129.26
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUPLX UP EXT ARTERY UNI
|
Facility
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
908100120
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$220.82 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Adventist Health Commercial |
$244.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$838.14
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$825.94
|
| Rate for Payer: Heritage Provider Network Senior |
$825.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
IP
|
$1,413.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.73
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$956.60
|
| Rate for Payer: Heritage Provider Network Senior |
$956.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
|
|
HC DUP SCAN EXTRACRANIAL ART COMPLEX
|
Facility
OP
|
$1,413.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
908100102
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$244.36 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Adventist Health Commercial |
$282.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$369.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$970.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$827.62
|
| Rate for Payer: Blue Shield of California EPN |
$470.64
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cash Price |
$635.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$918.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.65
|
| Rate for Payer: Heritage Provider Network Senior |
$874.65
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$244.36
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$336.78
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
OP
|
$961.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.93 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$368.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$593.68
|
| Rate for Payer: Blue Shield of California EPN |
$337.61
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.86
|
| Rate for Payer: Heritage Provider Network Senior |
$594.86
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$118.93
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DUP SCAN EXTRACRANIAL ART LIMITED
|
Facility
IP
|
$961.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
908100116
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$173.94 |
| Max. Negotiated Rate |
$720.75 |
| Rate for Payer: Adventist Health Commercial |
$192.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$660.21
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.60
|
| Rate for Payer: Heritage Provider Network Senior |
$650.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.25
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$853.50 |
| Rate for Payer: Adventist Health Commercial |
$227.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$298.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$739.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.42
|
| Rate for Payer: Heritage Provider Network Senior |
$704.42
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medi-Cal |
$181.85
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
