|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: TriValley Medical Group Senior |
$50.40
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.85
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.14
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.85
|
| Rate for Payer: Blue Shield of California Commercial |
$101.26
|
| Rate for Payer: Blue Shield of California EPN |
$81.01
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.86
|
| Rate for Payer: Heritage Provider Network Senior |
$76.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.40
|
| Rate for Payer: TriValley Medical Group Senior |
$66.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.86
|
| Rate for Payer: Heritage Provider Network Senior |
$76.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.96
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.86
|
| Rate for Payer: Heritage Provider Network Senior |
$76.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.96
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.85
|
| Rate for Payer: Blue Shield of California Commercial |
$101.26
|
| Rate for Payer: Blue Shield of California EPN |
$81.01
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.86
|
| Rate for Payer: Heritage Provider Network Senior |
$76.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.40
|
| Rate for Payer: TriValley Medical Group Senior |
$66.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.65
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.58
|
| Rate for Payer: Heritage Provider Network Senior |
$61.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.04
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.13
|
| Rate for Payer: Blue Shield of California EPN |
$64.90
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.58
|
| Rate for Payer: Heritage Provider Network Senior |
$61.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$63.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.20
|
| Rate for Payer: TriValley Medical Group Senior |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$2,530.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$457.93 |
| Max. Negotiated Rate |
$4,526.64 |
| Rate for Payer: Adventist Health Commercial |
$506.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,563.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,897.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,526.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,234.64
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,644.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,150.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,150.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,644.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,566.07
|
| Rate for Payer: Heritage Provider Network Senior |
$1,566.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,206.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$457.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,771.00
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,265.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,265.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,150.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,150.50
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$2,530.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$457.93 |
| Max. Negotiated Rate |
$1,897.50 |
| Rate for Payer: Adventist Health Commercial |
$506.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,629.32
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,712.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,712.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$457.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.50
|
| Rate for Payer: Multiplan Commercial |
$1,897.50
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$2,216.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$401.10 |
| Max. Negotiated Rate |
$3,771.46 |
| Rate for Payer: Adventist Health Commercial |
$443.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,369.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,883.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,218.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,662.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,771.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,351.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,081.41
|
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,440.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,883.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,883.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,883.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,440.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,371.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,371.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,057.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,551.20
|
| Rate for Payer: Multiplan Commercial |
$1,662.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,108.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,108.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,883.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,883.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,883.60
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$2,216.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$401.10 |
| Max. Negotiated Rate |
$1,662.00 |
| Rate for Payer: Adventist Health Commercial |
$443.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,427.10
|
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,500.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,500.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.00
|
| Rate for Payer: Multiplan Commercial |
$1,662.00
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,456.20 |
| Max. Negotiated Rate |
$14,321.25 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,297.18
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,783.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,840.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,840.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,456.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,773.75
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,899.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,322.35
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
OP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,000.94 |
| Max. Negotiated Rate |
$21,835.83 |
| Rate for Payer: Adventist Health Commercial |
$3,819.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,201.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,835.83
|
| Rate for Payer: Blue Shield of California Commercial |
$11,647.95
|
| Rate for Payer: Blue Shield of California EPN |
$9,318.36
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,783.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,201.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,220.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,000.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,840.99
|
| Rate for Payer: Heritage Provider Network Senior |
$8,840.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,000.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,108.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,456.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,773.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,681.26
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,899.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,322.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2,201.03
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
OP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,532.89 |
| Max. Negotiated Rate |
$6,351.75 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,903.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,730.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,661.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,166.09
|
| Rate for Payer: Blue Shield of California EPN |
$4,132.87
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,895.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,903.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,730.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,420.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,730.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,921.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,921.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,730.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,039.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,532.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,989.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,318.59
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,387.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,387.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,059.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,804.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,595.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,903.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,730.29
|
|
|
HC IN111 PROSTASCINT UP TO 10 MCI
|
Facility
|
IP
|
$8,469.00
|
|
|
Service Code
|
CPT A9507
|
| Hospital Charge Code |
909301255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,532.89 |
| Max. Negotiated Rate |
$6,351.75 |
| Rate for Payer: Adventist Health Commercial |
$1,693.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,454.04
|
| Rate for Payer: Cash Price |
$3,811.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,895.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,573.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,921.15
|
| Rate for Payer: Heritage Provider Network Senior |
$3,921.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,532.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.25
|
| Rate for Payer: Multiplan Commercial |
$6,351.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,059.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,804.09
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$472.77 |
| Max. Negotiated Rate |
$1,959.00 |
| Rate for Payer: Adventist Health Commercial |
$522.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,682.13
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,768.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,768.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$472.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Multiplan Commercial |
$1,959.00
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$472.77 |
| Max. Negotiated Rate |
$6,216.71 |
| Rate for Payer: Adventist Health Commercial |
$522.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,220.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,959.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,216.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,593.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,274.66
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,697.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,220.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,220.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,220.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,697.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,616.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,616.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,245.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$472.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,828.40
|
| Rate for Payer: Multiplan Commercial |
$1,959.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,306.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,306.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,220.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,220.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,220.20
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$427.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$328.70
|
| Rate for Payer: Blue Shield of California EPN |
$261.58
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.48
|
| Rate for Payer: Heritage Provider Network Senior |
$468.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$330.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$415.20
|
| Rate for Payer: TriValley Medical Group Senior |
$415.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.25 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Adventist Health Commercial |
$138.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.65
|
| Rate for Payer: Cash Price |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.48
|
| Rate for Payer: Heritage Provider Network Senior |
$468.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.00
|
| Rate for Payer: Multiplan Commercial |
$519.00
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$616.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$587.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,806.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$711.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,045.63
|
| Rate for Payer: TriValley Medical Group Senior |
$1,045.63
|
| 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 |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$711.75 |
| Rate for Payer: Adventist Health Commercial |
$189.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.16
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$642.47
|
| Rate for Payer: Heritage Provider Network Senior |
$642.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.25
|
| Rate for Payer: Multiplan Commercial |
$711.75
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
OP
|
$5,873.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,174.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,629.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,789.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,219.99
|
| Rate for Payer: Cash Price |
$2,642.85
|
| Rate for Payer: Cash Price |
$2,642.85
|
| Rate for Payer: Cash Price |
$2,642.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,817.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,569.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,976.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3,976.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,801.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,063.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,105.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$4,404.75
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,523.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,523.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
IP
|
$5,873.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.01 |
| Max. Negotiated Rate |
$4,404.75 |
| Rate for Payer: Adventist Health Commercial |
$1,174.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,782.21
|
| Rate for Payer: Cash Price |
$2,642.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,976.02
|
| Rate for Payer: Heritage Provider Network Senior |
$3,976.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,063.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,468.25
|
| Rate for Payer: Multiplan Commercial |
$4,404.75
|
|
|
HC INCISION/DRAIN FOREARM/WRIST
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
900501423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,222.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,477.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.27
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,389.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,487.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,129.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,129.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
