|
HC EXTREMITY STUDY SIMPLE
|
Facility
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$185.34 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$703.49
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.25
|
| Rate for Payer: Heritage Provider Network Senior |
$693.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.00
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$236.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$703.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Blue Shield of California Commercial |
$379.09
|
| Rate for Payer: Blue Shield of California EPN |
$215.58
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$665.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.86
|
| Rate for Payer: Heritage Provider Network Senior |
$633.86
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$81.28
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$768.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
IP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.38 |
| Max. Negotiated Rate |
$2,898.00 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,654.57
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
OP
|
$3,864.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$4,379.50 |
| Rate for Payer: Adventist Health Commercial |
$772.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$152.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,654.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,511.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,615.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,615.93
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,862.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$699.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$966.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,403.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,290.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.77
|
| Rate for Payer: Blue Shield of California Commercial |
$83.23
|
| Rate for Payer: Blue Shield of California EPN |
$47.33
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.21
|
| Rate for Payer: Heritage Provider Network Senior |
$417.21
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$38.50
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
IP
|
$674.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
OP
|
$4,134.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.25 |
| Max. Negotiated Rate |
$4,367.44 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,840.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,687.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,687.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,798.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,798.72
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,992.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,501.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,381.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
IP
|
$4,134.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.25 |
| Max. Negotiated Rate |
$3,100.50 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,840.06
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,798.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,798.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,033.50
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
IP
|
$6,207.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,123.47 |
| Max. Negotiated Rate |
$4,655.25 |
| Rate for Payer: Adventist Health Commercial |
$1,241.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,264.21
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,202.14
|
| Rate for Payer: Heritage Provider Network Senior |
$4,202.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.75
|
| Rate for Payer: Multiplan Commercial |
$4,655.25
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
OP
|
$6,207.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$5,505.00 |
| Rate for Payer: Adventist Health Commercial |
$1,241.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,264.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Cash Price |
$2,793.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,034.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,202.14
|
| Rate for Payer: Heritage Provider Network Senior |
$4,202.14
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,991.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$4,655.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,253.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,073.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.87
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.31
|
| Rate for Payer: Heritage Provider Network Senior |
$173.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$166.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.31
|
| Rate for Payer: Heritage Provider Network Senior |
$173.31
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.87
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$92.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$85.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
IP
|
$952.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.31 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.02
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$644.50
|
| Rate for Payer: Heritage Provider Network Senior |
$644.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
OP
|
$952.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Adventist Health Commercial |
$190.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.49
|
| Rate for Payer: Blue Shield of California Commercial |
$161.94
|
| Rate for Payer: Blue Shield of California EPN |
$92.09
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$618.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.29
|
| Rate for Payer: Heritage Provider Network Senior |
$589.29
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$58.16
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC FACIAL BONES LIMITED
|
Facility
IP
|
$529.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$358.13
|
| Rate for Payer: Heritage Provider Network Senior |
$358.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
|
|
HC FACIAL BONES LIMITED
|
Facility
OP
|
$529.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.26
|
| Rate for Payer: Blue Shield of California Commercial |
$127.22
|
| Rate for Payer: Blue Shield of California EPN |
$72.34
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$343.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$327.45
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$108.70 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.70
|
| Rate for Payer: Blue Shield of California Commercial |
$101.40
|
| Rate for Payer: Blue Shield of California EPN |
$79.27
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Senior |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Humana Medicare |
$12.98
|
| Rate for Payer: IEHP Medi-Cal |
$18.00
|
| Rate for Payer: IEHP Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.35
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.98
|
| Rate for Payer: TriValley Medical Group Senior |
$12.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
IP
|
$1,090.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$197.29 |
| Max. Negotiated Rate |
$817.50 |
| Rate for Payer: Adventist Health Commercial |
$218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$748.83
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$737.93
|
| Rate for Payer: Heritage Provider Network Senior |
$737.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$817.50
|
|
|
HC FACTOR IX PTC
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$159.36 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.36
|
| Rate for Payer: Blue Shield of California Commercial |
$148.69
|
| Rate for Payer: Blue Shield of California EPN |
$116.24
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Senior |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$19.04
|
| Rate for Payer: IEHP Medi-Cal |
$26.41
|
| Rate for Payer: IEHP Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.04
|
| Rate for Payer: TriValley Medical Group Senior |
$19.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC FACTOR IX PTC
|
Facility
IP
|
$505.00
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900910029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$378.75 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.94
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.88
|
| Rate for Payer: Heritage Provider Network Senior |
$341.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.25
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
|
|
HC FACTOR V, ACG
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$147.75 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.75
|
| Rate for Payer: Blue Shield of California Commercial |
$137.85
|
| Rate for Payer: Blue Shield of California EPN |
$107.76
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.42
|
| Rate for Payer: Dignity Health Senior |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.47
|
| Rate for Payer: Heritage Provider Network Senior |
$41.47
|
| Rate for Payer: Humana Medicare |
$17.65
|
| Rate for Payer: IEHP Medi-Cal |
$24.48
|
| Rate for Payer: IEHP Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.24
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.65
|
| Rate for Payer: TriValley Medical Group Senior |
$17.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC FACTOR V, ACG
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
900910060
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$392.25 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.30
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.07
|
| Rate for Payer: Heritage Provider Network Senior |
$354.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.75
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
|
|
HC FACTOR VIII AHG
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.52
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC FACTOR VIII AHG
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900910028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$149.89 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.89
|
| Rate for Payer: Blue Shield of California Commercial |
$139.86
|
| Rate for Payer: Blue Shield of California EPN |
$109.34
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Humana Medicare |
$17.90
|
| Rate for Payer: IEHP Medi-Cal |
$24.74
|
| Rate for Payer: IEHP Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC FACTOR VII, (PROCONVERTIN)
|
Facility
OP
|
$68.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
900910027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$149.89 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.89
|
| Rate for Payer: Blue Shield of California Commercial |
$139.86
|
| Rate for Payer: Blue Shield of California EPN |
$109.34
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Humana Medicare |
$17.90
|
| Rate for Payer: IEHP Medi-Cal |
$24.82
|
| Rate for Payer: IEHP Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.55
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.90
|
| Rate for Payer: TriValley Medical Group Senior |
$17.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
