|
HC HSV 1&2 PCR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900912307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$133.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$162.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.75
|
| Rate for Payer: Heritage Provider Network Senior |
$154.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC HSV 1 IGG
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HSV 1 IGG
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC HSV 2 IGG
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$159.09
|
| Rate for Payer: Heritage Provider Network Senior |
$159.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
|
|
HC HSV 2 IGG
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913541
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$125.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$152.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$145.47
|
| Rate for Payer: Heritage Provider Network Senior |
$145.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HUMERUS
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$411.75 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$293.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$377.16
|
| 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 |
$148.99
|
| Rate for Payer: Blue Shield of California Commercial |
$120.91
|
| Rate for Payer: Blue Shield of California EPN |
$97.23
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$356.85
|
| 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 |
$356.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.83
|
| Rate for Payer: Heritage Provider Network Senior |
$339.83
|
| 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 |
$261.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.25
|
| 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 |
$411.75
|
| 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 HUMERUS
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
909001508
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.37 |
| Max. Negotiated Rate |
$411.75 |
| Rate for Payer: Adventist Health Commercial |
$109.80
|
| Rate for Payer: Cash Price |
$301.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$371.67
|
| Rate for Payer: Heritage Provider Network Senior |
$371.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.25
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Senior |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.87
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Multiplan WC |
$93.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Senior |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.87
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.49
|
| Rate for Payer: TriValley Medical Group Senior |
$58.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC HYDRATION INFUSION EA ADDL HR
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
910196361
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$263.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$496.24
|
| Rate for Payer: Heritage Provider Network Senior |
$496.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
|
|
HC HYDRATION INFUSION INITIAL 31-90MIN
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
910196360
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.11 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.70
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$476.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.47
|
| Rate for Payer: Dignity Health Senior |
$267.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$453.73
|
| Rate for Payer: Heritage Provider Network Senior |
$453.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.30
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.47
|
| Rate for Payer: TriValley Medical Group Senior |
$267.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.47
|
| Rate for Payer: Vantage Medical Group Senior |
$267.70
|
|
|
HC HYDROCOIL
|
Facility
|
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,797.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,572.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,505.09
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,722.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Senior |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,396.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,733.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,733.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,872.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,352.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,239.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC HYDROCOIL
|
Facility
|
IP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,797.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.09
|
| Rate for Payer: Blue Shield of California EPN |
$1,505.09
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,722.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,021.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,733.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,733.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,872.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,352.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,239.64
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$560.56
|
| Rate for Payer: Heritage Provider Network Senior |
$560.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$442.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.08
|
| Rate for Payer: Blue Shield of California EPN |
$404.06
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$538.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Senior |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$512.53
|
| Rate for Payer: Heritage Provider Network Senior |
$512.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$394.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$414.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$311.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$249.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$249.15
|
| Rate for Payer: Cash Price |
$249.15
|
| Rate for Payer: Cash Price |
$249.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$294.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$385.05
|
| Rate for Payer: Dignity Health Senior |
$385.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$280.41
|
| Rate for Payer: Heritage Provider Network Senior |
$280.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$216.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$317.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$317.10
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$385.05
|
| Rate for Payer: Vantage Medical Group Senior |
$385.05
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.99 |
| Max. Negotiated Rate |
$339.75 |
| Rate for Payer: Adventist Health Commercial |
$90.60
|
| Rate for Payer: Cash Price |
$249.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$306.68
|
| Rate for Payer: Heritage Provider Network Senior |
$306.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$339.75
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
IP
|
$1,957.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$1,467.75 |
| Rate for Payer: Adventist Health Commercial |
$391.40
|
| Rate for Payer: Cash Price |
$1,076.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,324.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,324.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.25
|
| Rate for Payer: Multiplan Commercial |
$1,467.75
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,957.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$1,467.75 |
| Rate for Payer: Adventist Health Commercial |
$391.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,046.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,344.46
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$338.54
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$1,076.35
|
| Rate for Payer: Cash Price |
$1,076.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,272.05
|
| 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 |
$1,272.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,211.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$933.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.25
|
| 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 |
$1,467.75
|
| 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 |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| 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
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.90
|
| Rate for Payer: Blue Shield of California Commercial |
$895.48
|
| Rate for Payer: Blue Shield of California EPN |
$716.38
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$849.90
|
| Rate for Payer: Dignity Health Senior |
$849.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$772.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.68
|
| Rate for Payer: Heritage Provider Network Senior |
$679.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$772.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$700.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$888.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.53
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$587.20
|
| Rate for Payer: TriValley Medical Group Senior |
$587.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$530.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$486.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Vantage Medical Group Senior |
$849.90
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$1,101.00 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Cash Price |
$807.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$675.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$679.68
|
| Rate for Payer: Heritage Provider Network Senior |
$679.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.00
|
| Rate for Payer: Multiplan Commercial |
$1,101.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$530.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$486.05
|
|
