|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.06 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$452.09
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$475.25
|
| Rate for Payer: Heritage Provider Network Senior |
$475.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
|
|
HC LOW COST SKIN SUB T/A/L EACH ADD 25 SQCM
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT C5272
|
| Hospital Charge Code |
900101510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.06 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$433.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$526.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.14
|
| Rate for Payer: Blue Shield of California Commercial |
$428.22
|
| Rate for Payer: Blue Shield of California EPN |
$342.58
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$456.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$434.54
|
| Rate for Payer: Heritage Provider Network Senior |
$434.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$334.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$351.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$351.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$230.59 |
| Max. Negotiated Rate |
$1,077.00 |
| Rate for Payer: Adventist Health Commercial |
$254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.25
|
| Rate for Payer: Blue Shield of California Commercial |
$761.28
|
| Rate for Payer: Blue Shield of California EPN |
$612.20
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$277.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.61
|
| Rate for Payer: Heritage Provider Network Senior |
$788.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$305.48
|
| Rate for Payer: TriValley Medical Group Senior |
$277.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC LOWER EXT ARTERIAL EXAM, BILAT
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
908100113
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$230.59 |
| Max. Negotiated Rate |
$955.50 |
| Rate for Payer: Adventist Health Commercial |
$254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.46
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$862.50
|
| Rate for Payer: Heritage Provider Network Senior |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.08
|
| Rate for Payer: Blue Shield of California Commercial |
$242.78
|
| Rate for Payer: Blue Shield of California EPN |
$194.22
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$258.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.36
|
| Rate for Payer: Heritage Provider Network Senior |
$246.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$189.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$258.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$526.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$443.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC LOW FREQ NON-CONTACT/THRMAL US
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 97610
|
| Hospital Charge Code |
900803112
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$298.50 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$256.31
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$269.45
|
| Rate for Payer: Heritage Provider Network Senior |
$269.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.50
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.86
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.45
|
| Rate for Payer: Heritage Provider Network Senior |
$422.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
|
|
HC LOW MIGRAT STAGE IV CONF & ID
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$585.08 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$385.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.08
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$336.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$405.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$386.26
|
| Rate for Payer: Heritage Provider Network Senior |
$320.64
|
| Rate for Payer: Heritage Provider Network Senior |
$386.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$297.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
905350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$388.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,249.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$779.88
|
| Rate for Payer: Blue Shield of California EPN |
$779.88
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$892.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,047.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$898.22
|
| Rate for Payer: Heritage Provider Network Senior |
$898.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$970.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$700.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$642.33
|
|
|
HC LSO SAG-CORO REGID FRAME PRE
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT L0631
|
| Hospital Charge Code |
905350631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$795.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,198.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,067.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,455.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$779.88
|
| Rate for Payer: Blue Shield of California EPN |
$779.88
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cash Price |
$873.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$892.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,649.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,649.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$898.22
|
| Rate for Payer: Heritage Provider Network Senior |
$898.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$970.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$970.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,358.00
|
| Rate for Payer: Multiplan Commercial |
$1,455.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$700.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$642.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,649.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,649.00
|
|
|
HC LTD TAGGED WBC SCAN LIMITED
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 78805
|
| Hospital Charge Code |
909301442
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$1,846.50 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,585.53
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,666.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,666.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
|
|
HC LTD TAGGED WBC SCAN LIMITED
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 78805
|
| Hospital Charge Code |
909301442
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$445.62 |
| Max. Negotiated Rate |
$2,092.70 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,521.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,501.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,201.46
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,600.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,092.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,600.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,523.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,523.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,174.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$445.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$615.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,723.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,231.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,231.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$507.47
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.48
|
| Rate for Payer: Heritage Provider Network Senior |
$533.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
|
|
HC LUMBAR DISCOGRAPHY, 1 LEVEL
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
909000183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$669.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$433.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$669.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$669.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$669.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.77
|
| Rate for Payer: Heritage Provider Network Senior |
$487.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$375.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$551.60
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$669.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$669.80
|
| Rate for Payer: Vantage Medical Group Senior |
$669.80
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.89 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$426.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$379.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$517.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$448.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$586.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$586.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$586.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.11
|
| Rate for Payer: Heritage Provider Network Senior |
$427.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$329.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$483.00
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$586.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$586.50
|
| Rate for Payer: Vantage Medical Group Senior |
$586.50
|
|
|
HC LUMBAR PUNCTURE FOR MYELOGR
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
909000181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.89 |
| Max. Negotiated Rate |
$517.50 |
| Rate for Payer: Adventist Health Commercial |
$138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$444.36
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.13
|
| Rate for Payer: Heritage Provider Network Senior |
$467.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$124.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.50
|
| Rate for Payer: Multiplan Commercial |
$517.50
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$558.75 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$479.78
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$504.37
|
| Rate for Payer: Heritage Provider Network Senior |
$504.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
|
|
HC LUMBAR/SACRAL FACET INJ 3RD EA
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
909020044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.84 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$460.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| 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 |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$484.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.15
|
| Rate for Payer: Heritage Provider Network Senior |
$461.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$355.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,009.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$898.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,225.50
|
| 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 |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,062.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,388.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,388.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,011.45
|
| Rate for Payer: Heritage Provider Network Senior |
$1,011.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$779.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,143.80
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,388.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,388.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,388.90
|
|
|
HC LUMBAR/SACRAL FACET INJECT/ADD
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
909000186
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,052.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,106.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,106.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$295.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.50
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,766.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| 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 |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,857.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,714.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,769.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC LUMBAR/SACRAL FACET INJECT/INT
|
Facility
|
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
909000185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.30 |
| Max. Negotiated Rate |
$2,143.50 |
| Rate for Payer: Adventist Health Commercial |
$571.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,840.55
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,934.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,934.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.50
|
| Rate for Payer: Multiplan Commercial |
$2,143.50
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$910.50 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$750.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$789.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$751.47
|
| Rate for Payer: Heritage Provider Network Senior |
$751.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$579.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC LUMBAR SPINE AP AND LATERAL
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$910.50 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$781.82
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$821.88
|
| Rate for Payer: Heritage Provider Network Senior |
$821.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.50
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
|
|
HC LUMBAR SPINE LIMITED
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
909001136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$201.69 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.94
|
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.18
|
| Rate for Payer: Heritage Provider Network Senior |
$149.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$114.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$180.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
