|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
OP
|
$826.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$256.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$619.50
|
| Rate for Payer: Blue Shield of California Commercial |
$512.95
|
| Rate for Payer: Blue Shield of California EPN |
$484.86
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: Dignity Health Senior |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.29
|
| Rate for Payer: Heritage Provider Network Senior |
$511.29
|
| Rate for Payer: IEHP Medi-Cal |
$107.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$398.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$413.00
|
| Rate for Payer: TriValley Medical Group Senior |
$413.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
IP
|
$826.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.46
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.20
|
| Rate for Payer: Heritage Provider Network Senior |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
OP
|
$826.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Blue Shield of California Commercial |
$512.95
|
| Rate for Payer: Blue Shield of California EPN |
$484.86
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: Dignity Health Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$165.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.29
|
| Rate for Payer: Heritage Provider Network Senior |
$511.29
|
| Rate for Payer: Humana Medicare |
$165.16
|
| Rate for Payer: IEHP Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$413.00
|
| Rate for Payer: TriValley Medical Group Senior |
$413.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
OP
|
$645.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$91.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$310.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$215.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
IP
|
$645.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$483.75 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
|
|
HC INJ AA AND OR STRD SUPCPLR NRV
|
Facility
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
909004418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC INJ AA AND OR STRD SUPCPLR NRV
|
Facility
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
909004418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$94.66
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ AA AND OR STROID PUNDL NRV
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
909004430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.42 |
| Max. Negotiated Rate |
$1,696.50 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,531.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,531.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
|
|
HC INJ AA AND OR STROID PUNDL NRV
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
909004430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.18 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,470.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$109.18
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ AA/STRD GNCLR NRV BRNCH
|
Facility
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
900100992
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$304.23
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ AA/STRD GNCLR NRV BRNCH
|
Facility
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
900100992
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
OP
|
$620.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$527.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$341.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$465.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$403.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.00
|
| Rate for Payer: Dignity Health Senior |
$527.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.78
|
| Rate for Payer: Heritage Provider Network Senior |
$383.78
|
| Rate for Payer: IEHP Medi-Cal |
$63.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$298.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$527.00
|
| Rate for Payer: Vantage Medical Group Senior |
$527.00
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
IP
|
$620.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$124.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$425.94
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.74
|
| Rate for Payer: Heritage Provider Network Senior |
$419.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
IP
|
$853.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$639.75 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.01
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$577.48
|
| Rate for Payer: Heritage Provider Network Senior |
$577.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.25
|
| Rate for Payer: Multiplan Commercial |
$639.75
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
OP
|
$853.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$170.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$554.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.01
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: IEHP Medi-Cal |
$98.16
|
| Rate for Payer: IEHP Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$639.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ ANES ILIOING ILIOHYPO NRV
|
Facility
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$107.45
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ ANES ILIOING ILIOHYPO NRV
|
Facility
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC INJ ANES INTERCSTL NRV REG BLCK
|
Facility
OP
|
$2,113.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
909064421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$422.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$950.85
|
| Rate for Payer: Cash Price |
$950.85
|
| Rate for Payer: Cash Price |
$950.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,373.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,267.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.95
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$131.84
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,584.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ ANES INTERCSTL NRV REG BLCK
|
Facility
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
909064421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.45 |
| Max. Negotiated Rate |
$1,584.75 |
| Rate for Payer: Adventist Health Commercial |
$422.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,451.63
|
| Rate for Payer: Cash Price |
$950.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,430.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,430.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.25
|
| Rate for Payer: Multiplan Commercial |
$1,584.75
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,470.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$130.68
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.42 |
| Max. Negotiated Rate |
$1,696.50 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,531.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,531.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
|
|
HC INJ ANES SCIATIC NRV SNGLE
|
Facility
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
900100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC INJ ANES SCIATIC NRV SNGLE
|
Facility
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
900100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.55 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cash Price |
$783.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,044.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: IEHP Medi-Cal |
$122.55
|
| Rate for Payer: IEHP Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC INJ ANES STELLATE GANGLION
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.42 |
| Max. Negotiated Rate |
$1,696.50 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,531.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,531.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
|
|
HC INJ ANES STELLATE GANGLION
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$452.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,553.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cash Price |
$1,017.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,470.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: IEHP Medi-Cal |
$94.66
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,696.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
