|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cash Price |
$1,111.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| 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 |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Senior |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.64
|
| Rate for Payer: Heritage Provider Network Senior |
$398.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| 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 |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$442.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$418.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Senior |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$231.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$213.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$435.99
|
| Rate for Payer: Heritage Provider Network Senior |
$435.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,411.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| 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 |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Senior |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,932.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,152.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ANGRPHY MAPCA
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93575
|
| Hospital Charge Code |
906820298
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY BI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93573
|
| Hospital Charge Code |
906820296
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,411.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| 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 |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Senior |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,932.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,152.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,411.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| 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 |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Senior |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,932.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,152.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY ART ANGRPHY UNI
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93569
|
| Hospital Charge Code |
906820295
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$816.67 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
|
|
HC INJ CRDC CATH SLCTVE PLMNRY VN ANGRPHY
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
CPT 93574
|
| Hospital Charge Code |
906820297
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,411.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,099.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,481.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,384.00
|
| 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 |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,932.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,835.20
|
| Rate for Payer: Dignity Health Senior |
$3,835.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,932.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,792.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,792.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,152.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$816.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,158.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,158.40
|
| Rate for Payer: Multiplan Commercial |
$3,384.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,835.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,835.20
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$2,156.25 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
|
|
HC INJ CRV/THRC INC CATH W GUID
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
907262325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,975.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,868.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,725.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,779.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.24 |
| Max. Negotiated Rate |
$3,282.75 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,963.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,963.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.25
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
|
|
HC INJ CRV/THRC INC CATH WO GUID
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
907262324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,007.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cash Price |
$1,969.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,845.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,626.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,709.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,094.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
IP
|
$2,709.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,031.75 |
| Rate for Payer: Adventist Health Commercial |
$541.80
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,833.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,833.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.25
|
| Rate for Payer: Multiplan Commercial |
$2,031.75
|
|
|
HC INJECT ANES AGENT CELIAC PLEXUS
|
Facility
|
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
909000187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$365.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,255.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,187.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,370.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
OP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.23 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,510.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,411.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,015.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$3,609.45
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,213.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,817.85
|
| Rate for Payer: Dignity Health Senior |
$6,817.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,965.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,965.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$814.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,826.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,614.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,614.70
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,817.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,817.85
|
|
|
HC INJECT/ASPIRATE LIVER CYST
|
Facility
|
IP
|
$8,021.00
|
|
|
Service Code
|
CPT 47015
|
| Hospital Charge Code |
909081848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,451.80 |
| Max. Negotiated Rate |
$6,015.75 |
| Rate for Payer: Adventist Health Commercial |
$1,604.20
|
| Rate for Payer: Cash Price |
$3,609.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,430.22
|
| Rate for Payer: Heritage Provider Network Senior |
$5,430.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,451.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,005.25
|
| Rate for Payer: Multiplan Commercial |
$6,015.75
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.28 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$517.23
|
| Rate for Payer: Heritage Provider Network Senior |
$517.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
|
|
HC INJECT, INTRALESIONL LT 7 LSNS
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
902811900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$496.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$517.23
|
| Rate for Payer: Heritage Provider Network Senior |
$517.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$364.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$252.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$734.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Senior |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$734.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$421.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$765.01
|
| Rate for Payer: Heritage Provider Network Senior |
$765.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$539.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$531.03
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$406.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC INJECTION EYE DRUG
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
900501532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.53 |
| Max. Negotiated Rate |
$847.50 |
| Rate for Payer: Adventist Health Commercial |
$226.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$765.01
|
| Rate for Payer: Heritage Provider Network Senior |
$765.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.50
|
| Rate for Payer: Multiplan Commercial |
$847.50
|
|
