|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.83
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cash Price |
$279.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOREARM
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$440.25 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$403.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.32
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$322.85
|
| Rate for Payer: Cash Price |
$322.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$381.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$363.35
|
| Rate for Payer: Heritage Provider Network Senior |
$363.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOREARM
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$440.25 |
| Rate for Payer: Adventist Health Commercial |
$117.40
|
| Rate for Payer: Cash Price |
$322.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$397.40
|
| Rate for Payer: Heritage Provider Network Senior |
$397.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.75
|
| Rate for Payer: Multiplan Commercial |
$440.25
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.25
|
| Rate for Payer: Blue Shield of California Commercial |
$107.90
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.60
|
| Rate for Payer: Heritage Provider Network Senior |
$694.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$205.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$704.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$666.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$694.60
|
| Rate for Payer: Heritage Provider Network Senior |
$694.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$489.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$769.50
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$369.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$339.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC FO SAFETY PIN WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$99.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.29
|
| Rate for Payer: Blue Shield of California EPN |
$58.29
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Senior |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC FO SAFETY PIN WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309135
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.29
|
| Rate for Payer: Blue Shield of California EPN |
$58.29
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.25
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.01
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.30
|
| Rate for Payer: Blue Shield of California Commercial |
$72.58
|
| Rate for Payer: Blue Shield of California EPN |
$58.21
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Senior |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.37
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.02
|
| Rate for Payer: TriValley Medical Group Senior |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.17
|
| Rate for Payer: Heritage Provider Network Senior |
$404.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$319.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$410.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.36
|
| Rate for Payer: Blue Shield of California Commercial |
$98.69
|
| Rate for Payer: Blue Shield of California EPN |
$79.36
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$388.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$369.54
|
| Rate for Payer: Heritage Provider Network Senior |
$369.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$284.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC FSH
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC FSH
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.64
|
| Rate for Payer: Blue Shield of California Commercial |
$149.59
|
| Rate for Payer: Blue Shield of California EPN |
$119.98
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Senior |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.41
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.58
|
| Rate for Payer: TriValley Medical Group Senior |
$18.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$7,646.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,383.93 |
| Max. Negotiated Rate |
$5,734.50 |
| Rate for Payer: Adventist Health Commercial |
$1,529.20
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,176.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,383.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.50
|
| Rate for Payer: Multiplan Commercial |
$5,734.50
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$7,646.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,529.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,252.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cash Price |
$4,205.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,969.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,176.34
|
| Rate for Payer: Heritage Provider Network Senior |
$5,176.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,647.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,383.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,911.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$5,734.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,751.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,531.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$8,392.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,765.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,615.60
|
| Rate for Payer: Cash Price |
$4,615.60
|
| Rate for Payer: Cash Price |
$4,615.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,454.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,681.38
|
| Rate for Payer: Heritage Provider Network Senior |
$5,681.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,002.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$6,294.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,019.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,778.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$8,392.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,518.95 |
| Max. Negotiated Rate |
$6,294.00 |
| Rate for Payer: Adventist Health Commercial |
$1,678.40
|
| Rate for Payer: Cash Price |
$4,615.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,681.38
|
| Rate for Payer: Heritage Provider Network Senior |
$5,681.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.00
|
| Rate for Payer: Multiplan Commercial |
$6,294.00
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$7,911.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,431.89 |
| Max. Negotiated Rate |
$5,933.25 |
| Rate for Payer: Adventist Health Commercial |
$1,582.20
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,355.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,355.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,431.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,977.75
|
| Rate for Payer: Multiplan Commercial |
$5,933.25
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$7,911.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,582.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,434.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cash Price |
$4,351.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,142.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,355.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,355.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,773.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,431.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,977.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$5,933.25
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,846.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,619.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,055.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,647.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,436.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.79
|
| Rate for Payer: Heritage Provider Network Senior |
$127.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.38
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Blue Shield of California Commercial |
$168.36
|
| Rate for Payer: Blue Shield of California EPN |
$134.69
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Senior |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.79
|
| Rate for Payer: Heritage Provider Network Senior |
$127.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$131.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$91.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
