|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,581.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,442.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,792.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,351.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,243.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$3,757.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$680.02 |
| Max. Negotiated Rate |
$2,817.75 |
| Rate for Payer: Adventist Health Commercial |
$751.40
|
| Rate for Payer: Cash Price |
$2,066.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,543.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,543.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$939.25
|
| Rate for Payer: Multiplan Commercial |
$2,817.75
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,657.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,247.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,598.11
|
| Rate for Payer: Cash Price |
$2,928.20
|
| Rate for Payer: Cash Price |
$2,928.20
|
| Rate for Payer: Cash Price |
$2,928.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,460.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,295.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,295.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,539.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,973.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,973.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,662.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,662.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$963.64 |
| Max. Negotiated Rate |
$3,993.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Cash Price |
$2,928.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,604.35
|
| Rate for Payer: Heritage Provider Network Senior |
$3,604.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$963.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.00
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
|
|
HC PID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.69
|
| Rate for Payer: Blue Shield of California Commercial |
$65.03
|
| Rate for Payer: Blue Shield of California EPN |
$52.16
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC PID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.20
|
| Rate for Payer: Heritage Provider Network Senior |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$685.59 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$277.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$356.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.12
|
| Rate for Payer: Blue Shield of California Commercial |
$269.52
|
| Rate for Payer: Blue Shield of California EPN |
$216.74
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Senior |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$457.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$247.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$575.90
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$457.06
|
| Rate for Payer: TriValley Medical Group Senior |
$457.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$174.99 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.99
|
| Rate for Payer: Blue Shield of California Commercial |
$132.14
|
| Rate for Payer: Blue Shield of California EPN |
$106.27
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Senior |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC PIN WORM PREP
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.33
|
| Rate for Payer: Heritage Provider Network Senior |
$69.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIN WORM PREP
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.82
|
| Rate for Payer: Heritage Provider Network Senior |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PIPERACILLIN/TAZOBACTAM E TEST
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912422
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cash Price |
$56.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$63.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,198.84 |
| Max. Negotiated Rate |
$17,398.50 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Cash Price |
$12,758.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,705.05
|
| Rate for Payer: Heritage Provider Network Senior |
$15,705.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,198.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,799.50
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$23,198.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
909081666
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,398.50 |
| Rate for Payer: Adventist Health Commercial |
$4,639.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,937.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| 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 |
$12,758.90
|
| Rate for Payer: Cash Price |
$12,758.90
|
| Rate for Payer: Cash Price |
$12,758.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15,078.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,359.56
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$317.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,198.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,799.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$17,398.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
IP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,651.13 |
| Max. Negotiated Rate |
$15,129.00 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Cash Price |
$11,094.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,656.44
|
| Rate for Payer: Heritage Provider Network Senior |
$13,656.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,651.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Multiplan Commercial |
$15,129.00
|
|
|
HC PLACEMENT OF IVC FILTER
|
Facility
|
OP
|
$20,172.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
906820197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,129.00 |
| Rate for Payer: Adventist Health Commercial |
$4,034.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,858.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| 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 |
$11,094.60
|
| Rate for Payer: Cash Price |
$11,094.60
|
| Rate for Payer: Cash Price |
$11,094.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,111.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,486.47
|
| Rate for Payer: Heritage Provider Network Senior |
$8,448.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$317.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,050.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,651.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,043.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$15,129.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,555.33
|
| Rate for Payer: TriValley Medical Group Senior |
$7,555.33
|
| 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 |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC PLACENTAL ALPHA MICROGLOB-1POC
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
900912139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$513.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$659.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$466.26
|
| Rate for Payer: Blue Shield of California Commercial |
$522.09
|
| Rate for Payer: Blue Shield of California EPN |
$418.76
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.92
|
| Rate for Payer: Dignity Health Senior |
$98.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$624.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$98.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.24
|
| Rate for Payer: Heritage Provider Network Senior |
$594.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$98.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$457.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.62
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$98.11
|
| Rate for Payer: TriValley Medical Group Senior |
$98.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$105.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$105.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$147.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.92
|
| Rate for Payer: Vantage Medical Group Senior |
$98.11
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
IP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$189.51 |
| Max. Negotiated Rate |
$785.25 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Cash Price |
$575.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.82
|
| Rate for Payer: Heritage Provider Network Senior |
$708.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.75
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
|
|
HC PLASMA IRON TURNOVER
|
Facility
|
OP
|
$1,047.00
|
|
| Hospital Charge Code |
909301337
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$189.51 |
| Max. Negotiated Rate |
$889.95 |
| Rate for Payer: Adventist Health Commercial |
$209.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$559.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.25
|
| Rate for Payer: Blue Shield of California Commercial |
$638.67
|
| Rate for Payer: Blue Shield of California EPN |
$510.94
|
| Rate for Payer: Cash Price |
$575.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$680.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.95
|
| Rate for Payer: Dignity Health Senior |
$889.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.09
|
| Rate for Payer: Heritage Provider Network Senior |
$648.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$499.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$732.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$732.90
|
| Rate for Payer: Multiplan Commercial |
$785.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$523.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$523.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$889.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.95
|
| Rate for Payer: Vantage Medical Group Senior |
$889.95
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC PLASTIC REPAIR OF CANALICULI
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 68700
|
| Hospital Charge Code |
900501395
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,352.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cash Price |
$2,684.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Senior |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,964.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,734.97
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,755.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,615.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PLASTY BALLOON/ACCENT
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909081210
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.60
|
| Rate for Payer: Blue Shield of California EPN |
$120.60
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| 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 |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| 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: United Healthcare All Other HMO/non HMO |
$108.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.33
|
| 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
|
|
