|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$195.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$672.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Cash Price |
$538.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$636.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.78
|
| Rate for Payer: Heritage Provider Network Senior |
$662.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$466.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$352.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$324.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$419.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$316.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.46 |
| Max. Negotiated Rate |
$826.50 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$746.05
|
| Rate for Payer: Heritage Provider Network Senior |
$746.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.50
|
| Rate for Payer: Multiplan Commercial |
$826.50
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$757.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cash Price |
$606.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$716.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$746.05
|
| Rate for Payer: Heritage Provider Network Senior |
$746.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$525.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$826.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$396.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$364.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$438.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,504.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,204.50
|
| Rate for Payer: Cash Price |
$1,204.50
|
| Rate for Payer: Cash Price |
$1,204.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,482.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,482.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,044.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$1,642.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$787.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$725.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$396.39 |
| Max. Negotiated Rate |
$1,642.50 |
| Rate for Payer: Adventist Health Commercial |
$438.00
|
| Rate for Payer: Cash Price |
$1,204.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,482.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,482.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$1,642.50
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$518.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$271.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$249.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$565.50 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
|
|
HC LDCT LUNG CANCER SCREENING
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT G0297
|
| Hospital Charge Code |
909200297
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
|
|
HC LDCT LUNG CANCER SCREENING
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT G0297
|
| Hospital Charge Code |
909200297
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$183.00
|
| Rate for Payer: Blue Shield of California EPN |
$146.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$910.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$874.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.00
|
| Rate for Payer: Heritage Provider Network Senior |
$521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$52,096.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906820135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$39,072.00 |
| Rate for Payer: Adventist Health Commercial |
$10,419.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,789.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| 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 |
$28,652.80
|
| Rate for Payer: Cash Price |
$28,652.80
|
| Rate for Payer: Cash Price |
$28,652.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33,862.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Senior |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,247.42
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$452.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,264.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,754.53
|
| Rate for Payer: Multiplan Commercial |
$39,072.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,626.98
|
| Rate for Payer: TriValley Medical Group Senior |
$14,626.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
OP
|
$42,892.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$32,169.00 |
| Rate for Payer: Adventist Health Commercial |
$8,578.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29,466.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,297.25
|
| 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 |
$23,590.60
|
| Rate for Payer: Cash Price |
$23,590.60
|
| Rate for Payer: Cash Price |
$23,590.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27,879.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,626.98
|
| Rate for Payer: Dignity Health Senior |
$13,297.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,297.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,550.15
|
| Rate for Payer: Heritage Provider Network Senior |
$16,355.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$452.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,297.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25,264.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,763.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,291.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,723.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,754.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,754.53
|
| Rate for Payer: Multiplan Commercial |
$32,169.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,626.98
|
| Rate for Payer: TriValley Medical Group Senior |
$14,626.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,945.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,626.98
|
| Rate for Payer: Vantage Medical Group Senior |
$13,297.25
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$52,096.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906820135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,429.38 |
| Max. Negotiated Rate |
$39,072.00 |
| Rate for Payer: Adventist Health Commercial |
$10,419.20
|
| Rate for Payer: Cash Price |
$28,652.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$35,268.99
|
| Rate for Payer: Heritage Provider Network Senior |
$35,268.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,429.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,024.00
|
| Rate for Payer: Multiplan Commercial |
$39,072.00
|
|
|
HC LEAD INSERT CS, EXIST IMPL
|
Facility
|
IP
|
$42,892.00
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
906812214
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,763.45 |
| Max. Negotiated Rate |
$32,169.00 |
| Rate for Payer: Adventist Health Commercial |
$8,578.40
|
| Rate for Payer: Cash Price |
$23,590.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,037.88
|
| Rate for Payer: Heritage Provider Network Senior |
$29,037.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,763.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,723.00
|
| Rate for Payer: Multiplan Commercial |
$32,169.00
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$34,836.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906820136
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$29,610.60 |
| Rate for Payer: Adventist Health Commercial |
$6,967.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,932.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29,610.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19,159.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26,127.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$19,159.80
|
| Rate for Payer: Cash Price |
$19,159.80
|
| Rate for Payer: Cash Price |
$19,159.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,643.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29,610.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$29,610.60
|
| Rate for Payer: Dignity Health Senior |
$29,610.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,563.48
|
| Rate for Payer: Heritage Provider Network Senior |
$21,563.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16,616.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,305.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,709.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24,385.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24,385.20
|
| Rate for Payer: Multiplan Commercial |
$26,127.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29,610.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29,610.60
|
| Rate for Payer: Vantage Medical Group Senior |
$29,610.60
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$34,836.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906820136
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,305.32 |
| Max. Negotiated Rate |
$26,127.00 |
| Rate for Payer: Adventist Health Commercial |
$6,967.20
|
| Rate for Payer: Cash Price |
$19,159.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,583.97
|
| Rate for Payer: Heritage Provider Network Senior |
$23,583.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,305.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,709.00
|
| Rate for Payer: Multiplan Commercial |
$26,127.00
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
IP
|
$31,297.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,664.76 |
| Max. Negotiated Rate |
$23,472.75 |
| Rate for Payer: Adventist Health Commercial |
$6,259.40
|
| Rate for Payer: Cash Price |
$17,213.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,188.07
|
| Rate for Payer: Heritage Provider Network Senior |
$21,188.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,664.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,824.25
|
| Rate for Payer: Multiplan Commercial |
$23,472.75
|
|
|
HC LEAD INSERT CS INITIAL IMPL
|
Facility
|
OP
|
$31,297.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
906812215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$26,602.45 |
| Rate for Payer: Adventist Health Commercial |
$6,259.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,501.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,602.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,213.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,472.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$17,213.35
|
| Rate for Payer: Cash Price |
$17,213.35
|
| Rate for Payer: Cash Price |
$17,213.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,343.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,602.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,602.45
|
| Rate for Payer: Dignity Health Senior |
$26,602.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,372.84
|
| Rate for Payer: Heritage Provider Network Senior |
$19,372.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,928.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,664.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,824.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,907.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,907.90
|
| Rate for Payer: Multiplan Commercial |
$23,472.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,767.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,783.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,602.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,602.45
|
| Rate for Payer: Vantage Medical Group Senior |
$26,602.45
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$15,895.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906820117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,876.99 |
| Max. Negotiated Rate |
$11,921.25 |
| Rate for Payer: Adventist Health Commercial |
$3,179.00
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,760.92
|
| Rate for Payer: Heritage Provider Network Senior |
$10,760.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,876.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,973.75
|
| Rate for Payer: Multiplan Commercial |
$11,921.25
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
OP
|
$15,895.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906820117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$3,179.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,919.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Cash Price |
$8,742.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,331.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,839.00
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,876.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,973.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$11,921.25
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
OP
|
$12,964.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$2,592.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,906.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$7,130.20
|
| Rate for Payer: Cash Price |
$7,130.20
|
| Rate for Payer: Cash Price |
$7,130.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,426.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,024.72
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,346.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,241.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$9,723.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC LEAD INSERT DUAL A & V
|
Facility
|
IP
|
$12,964.00
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
906811360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,346.48 |
| Max. Negotiated Rate |
$9,723.00 |
| Rate for Payer: Adventist Health Commercial |
$2,592.80
|
| Rate for Payer: Cash Price |
$7,130.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,776.63
|
| Rate for Payer: Heritage Provider Network Senior |
$8,776.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,346.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,241.00
|
| Rate for Payer: Multiplan Commercial |
$9,723.00
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
IP
|
$12,445.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,252.55 |
| Max. Negotiated Rate |
$9,333.75 |
| Rate for Payer: Adventist Health Commercial |
$2,489.00
|
| Rate for Payer: Cash Price |
$6,844.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,425.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8,425.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,252.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,111.25
|
| Rate for Payer: Multiplan Commercial |
$9,333.75
|
|
|
HC LEAD INSERT, SINGLE A OR V
|
Facility
|
OP
|
$12,445.00
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
906811354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$2,489.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,549.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,844.75
|
| Rate for Payer: Cash Price |
$6,844.75
|
| Rate for Payer: Cash Price |
$6,844.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,089.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,103.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,703.45
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$723.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,252.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,111.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$9,333.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
