|
HC ENOVENOUS ABLATION THERAPY
|
Facility
OP
|
$20,992.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,102.89 |
| Max. Negotiated Rate |
$15,744.00 |
| Rate for Payer: Adventist Health Commercial |
$4,198.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,421.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,644.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,994.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$3,102.89
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,799.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,248.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$15,744.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$315.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.16
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.71
|
| Rate for Payer: Heritage Provider Network Senior |
$648.71
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: IEHP Medi-Cal |
$567.86
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.98
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$709.50
|
| Rate for Payer: Heritage Provider Network Senior |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
|
|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
OP
|
$2,683.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,843.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,743.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,660.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$670.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
IP
|
$2,683.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$485.62 |
| Max. Negotiated Rate |
$2,012.25 |
| Rate for Payer: Adventist Health Commercial |
$536.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,843.22
|
| Rate for Payer: Cash Price |
$1,207.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,816.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,816.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$670.75
|
| Rate for Payer: Multiplan Commercial |
$2,012.25
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$21.41 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.84
|
| Rate for Payer: Blue Shield of California EPN |
$15.51
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: IEHP Medi-Cal |
$3.53
|
| Rate for Payer: IEHP Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Senior |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$5.79
|
| Rate for Payer: IEHP Medi-Cal |
$7.22
|
| Rate for Payer: IEHP Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,184.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$878.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$661.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$608.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,089.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.18
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.34
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$118.48
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$864.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,089.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.18
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.34
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$118.48
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$864.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIFIX 2X3
|
Facility
IP
|
$759.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.84
|
| Rate for Payer: Heritage Provider Network Senior |
$513.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
|
|
HC EPIFIX 2X3
|
Facility
OP
|
$759.00
|
|
|
Service Code
|
CPT Q4186 JW
|
| Hospital Charge Code |
900101471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$405.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Blue Shield of California Commercial |
$471.34
|
| Rate for Payer: Blue Shield of California EPN |
$445.53
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Senior |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$365.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
|
HC EPS 3-D MAPPING
|
Facility
OP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$249.58 |
| Max. Negotiated Rate |
$8,809.40 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$249.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,120.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,809.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,700.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,773.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,736.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,809.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,809.40
|
| Rate for Payer: Dignity Health Senior |
$8,809.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,736.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,415.32
|
| Rate for Payer: Heritage Provider Network Senior |
$6,415.32
|
| Rate for Payer: IEHP Medi-Cal |
$487.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,995.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.00
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,809.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,809.40
|
|
|
HC EPS 3-D MAPPING
|
Facility
IP
|
$10,364.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906820081
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,875.88 |
| Max. Negotiated Rate |
$7,773.00 |
| Rate for Payer: Adventist Health Commercial |
$2,072.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,120.07
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Cash Price |
$4,663.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,875.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.00
|
| Rate for Payer: Multiplan Commercial |
$7,773.00
|
|
|
HC EPS 3-D MAPPING
|
Facility
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,306.28 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.08
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
|
|
HC EPS 3-D MAPPING
|
Facility
OP
|
$7,217.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
906812178
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$249.58 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$249.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,969.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,412.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cash Price |
$3,247.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,691.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,134.45
|
| Rate for Payer: Dignity Health Senior |
$6,134.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,691.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,467.32
|
| Rate for Payer: Heritage Provider Network Senior |
$4,467.32
|
| Rate for Payer: IEHP Medi-Cal |
$487.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,478.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,134.45
|
|
