|
HC GASTRO UGI WITH KUB
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$879.00 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$793.44
|
| Rate for Payer: Heritage Provider Network Senior |
$793.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.13 |
| Max. Negotiated Rate |
$996.20 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$626.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$644.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.00
|
| Rate for Payer: Blue Shield of California Commercial |
$714.92
|
| Rate for Payer: Blue Shield of California EPN |
$571.94
|
| Rate for Payer: Cash Price |
$644.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$761.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$996.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$996.20
|
| Rate for Payer: Dignity Health Senior |
$996.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$725.47
|
| Rate for Payer: Heritage Provider Network Senior |
$725.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$820.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$820.40
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$586.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$996.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$996.20
|
| Rate for Payer: Vantage Medical Group Senior |
$996.20
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.68
|
| Rate for Payer: Heritage Provider Network Senior |
$0.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Blue Shield of California Commercial |
$0.61
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Senior |
$0.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.62
|
| Rate for Payer: Heritage Provider Network Senior |
$0.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$2,590.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Adventist Health Commercial |
$518.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,384.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,779.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.40
|
| Rate for Payer: Blue Shield of California EPN |
$933.15
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,683.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,683.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,603.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,603.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$271.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,235.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,942.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,295.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,295.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$2,590.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$468.79 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Adventist Health Commercial |
$518.00
|
| Rate for Payer: Cash Price |
$1,424.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,753.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,753.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$647.50
|
| Rate for Payer: Multiplan Commercial |
$1,942.50
|
|
|
HC GATED FIRST PASS
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$1,098.91 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$693.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$891.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.91
|
| Rate for Payer: Blue Shield of California EPN |
$883.71
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$843.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$802.84
|
| Rate for Payer: Heritage Provider Network Senior |
$802.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$618.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$648.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$648.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC GATED FIRST PASS
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Cash Price |
$713.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$878.07
|
| Rate for Payer: Heritage Provider Network Senior |
$878.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.25
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
|
|
HC GB GALLBLADDER
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$372.75 |
| Rate for Payer: Adventist Health Commercial |
$99.40
|
| Rate for Payer: Cash Price |
$273.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$336.47
|
| Rate for Payer: Heritage Provider Network Senior |
$336.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
|
|
HC GB GALLBLADDER
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.26 |
| Max. Negotiated Rate |
$372.75 |
| Rate for Payer: Adventist Health Commercial |
$99.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$265.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$341.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.67
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$273.35
|
| Rate for Payer: Cash Price |
$273.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$323.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$307.64
|
| Rate for Payer: Heritage Provider Network Senior |
$307.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$237.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$372.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
IP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.13
|
| Rate for Payer: Blue Shield of California EPN |
$709.13
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.73
|
| Rate for Payer: Heritage Provider Network Senior |
$816.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$584.06
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
OP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$846.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,211.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,323.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$709.13
|
| Rate for Payer: Blue Shield of California EPN |
$709.13
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cash Price |
$970.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,499.40
|
| Rate for Payer: Dignity Health Senior |
$1,499.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.73
|
| Rate for Payer: Heritage Provider Network Senior |
$816.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$882.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,234.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,234.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$584.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,499.40
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,051.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Senior |
$1,300.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$979.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$734.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$615.06
|
| Rate for Payer: Blue Shield of California EPN |
$615.06
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.39
|
| Rate for Payer: Heritage Provider Network Senior |
$708.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$765.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$552.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$506.58
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,086.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,747.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,747.69
|
| Rate for Payer: Cash Price |
$2,391.12
|
| Rate for Payer: Cash Price |
$2,391.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,347.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,012.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,012.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,570.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,439.46
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,086.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,986.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,747.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,747.69
|
| Rate for Payer: Cash Price |
$2,391.12
|
| Rate for Payer: Cash Price |
$2,391.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,999.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Senior |
$3,695.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,782.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,012.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,012.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,043.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,043.25
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,570.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,439.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,039.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,039.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.02 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$820.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,055.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$936.96
|
| Rate for Payer: Blue Shield of California EPN |
$749.57
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$998.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Senior |
$1,305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$998.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$950.78
|
| Rate for Payer: Heritage Provider Network Senior |
$950.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$732.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$768.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.53
|
| Rate for Payer: Blue Shield of California Commercial |
$131.90
|
| Rate for Payer: Blue Shield of California EPN |
$105.80
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Senior |
$16.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.38
|
| Rate for Payer: TriValley Medical Group Senior |
$16.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$2,394.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,279.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,644.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,023.89
|
| Rate for Payer: Blue Shield of California EPN |
$823.38
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,556.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,481.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,481.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,141.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,197.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,197.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$2,394.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$433.31 |
| Max. Negotiated Rate |
$1,795.50 |
| Rate for Payer: Adventist Health Commercial |
$478.80
|
| Rate for Payer: Cash Price |
$1,316.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,620.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,620.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$1,795.50
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$1,016.25 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$724.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$930.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Blue Shield of California Commercial |
$321.50
|
| Rate for Payer: Blue Shield of California EPN |
$258.54
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Cash Price |
$745.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$880.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$838.75
|
| Rate for Payer: Heritage Provider Network Senior |
$838.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$646.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
