|
HC SBBB CRYOPRECIPITATE
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904563
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$97.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$261.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$335.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.46
|
| Rate for Payer: Blue Shield of California Commercial |
$298.29
|
| Rate for Payer: Blue Shield of California EPN |
$238.63
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$317.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.85
|
| Rate for Payer: Dignity Health Senior |
$80.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$80.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$302.69
|
| Rate for Payer: Heritage Provider Network Senior |
$302.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$233.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.77
|
| Rate for Payer: Multiplan Commercial |
$366.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$88.85
|
| Rate for Payer: TriValley Medical Group Senior |
$80.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Vantage Medical Group Senior |
$80.77
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$80.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.76
|
| Rate for Payer: Blue Shield of California Commercial |
$79.30
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.85
|
| Rate for Payer: Dignity Health Senior |
$80.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$80.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.77
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$88.85
|
| Rate for Payer: TriValley Medical Group Senior |
$80.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.85
|
| Rate for Payer: Vantage Medical Group Senior |
$80.77
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Blue Shield of California Commercial |
$92.72
|
| Rate for Payer: Blue Shield of California EPN |
$74.18
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB DD ADMIN FEE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904780
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$269.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$338.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.97
|
| Rate for Payer: Blue Shield of California Commercial |
$307.44
|
| Rate for Payer: Blue Shield of California EPN |
$245.95
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.84
|
| Rate for Payer: Dignity Health Senior |
$308.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.98
|
| Rate for Payer: Heritage Provider Network Senior |
$311.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$240.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$354.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$388.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$388.13
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$338.84
|
| Rate for Payer: TriValley Medical Group Senior |
$308.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.84
|
| Rate for Payer: Vantage Medical Group Senior |
$308.04
|
|
|
HC SBBB DEGLYC RBC LEUKO
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT P9054
|
| Hospital Charge Code |
900905006
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.21
|
| Rate for Payer: Heritage Provider Network Senior |
$341.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.77
|
| Rate for Payer: Heritage Provider Network Senior |
$530.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
|
|
HC SBBB DEGLYC RBC LEUKO IRRAD
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT P9057
|
| Hospital Charge Code |
900905007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$925.07 |
| Rate for Payer: Adventist Health Commercial |
$156.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$419.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$538.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$616.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.84
|
| Rate for Payer: Blue Shield of California Commercial |
$478.24
|
| Rate for Payer: Blue Shield of California EPN |
$382.59
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$509.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$678.38
|
| Rate for Payer: Dignity Health Senior |
$616.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$616.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$485.30
|
| Rate for Payer: Heritage Provider Network Senior |
$485.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$605.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$616.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$373.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$709.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$777.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$777.05
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$678.38
|
| Rate for Payer: TriValley Medical Group Senior |
$616.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$678.38
|
| Rate for Payer: Vantage Medical Group Senior |
$616.71
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.44
|
| Rate for Payer: Heritage Provider Network Senior |
$72.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
|
|
HC SBBB DIFF ADSORP
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$164.29 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.29
|
| Rate for Payer: Blue Shield of California Commercial |
$105.02
|
| Rate for Payer: Blue Shield of California EPN |
$84.46
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.23
|
| Rate for Payer: Heritage Provider Network Senior |
$66.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$75.47
|
| Rate for Payer: TriValley Medical Group Senior |
$75.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC SBBB DILUTION
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$131.47 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.47
|
| Rate for Payer: Blue Shield of California Commercial |
$38.40
|
| Rate for Payer: Blue Shield of California EPN |
$30.88
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Senior |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$31.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.43
|
| Rate for Payer: Heritage Provider Network Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.21
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$31.12
|
| Rate for Payer: TriValley Medical Group Senior |
$31.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SBBB DILUTION
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86976
|
| Hospital Charge Code |
900904738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Adventist Health Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.34
|
| Rate for Payer: Heritage Provider Network Senior |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$24.75
|
|
|
HC SBBB ELUTION
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.81
|
| Rate for Payer: Heritage Provider Network Senior |
$52.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
|
|
HC SBBB ELUTION
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904735
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$15.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.47
|
| Rate for Payer: Blue Shield of California Commercial |
$94.94
|
| Rate for Payer: Blue Shield of California EPN |
$76.35
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.28
|
| Rate for Payer: Heritage Provider Network Senior |
$48.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SBBB FFP APHERESIS TO 499 ML
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$99.55 |
| Max. Negotiated Rate |
$412.50 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$372.35
|
| Rate for Payer: Heritage Provider Network Senior |
$372.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.50
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
|
|
HC SBBB FFP APHERESIS TO 499 ML
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904726
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$110.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$293.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$377.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.07
|
| Rate for Payer: Blue Shield of California Commercial |
$335.50
|
| Rate for Payer: Blue Shield of California EPN |
$268.40
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$357.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.36
|
| Rate for Payer: Dignity Health Senior |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$340.45
|
| Rate for Payer: Heritage Provider Network Senior |
$340.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$262.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.82
|
| Rate for Payer: Multiplan Commercial |
$412.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.36
|
| Rate for Payer: TriValley Medical Group Senior |
$90.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Vantage Medical Group Senior |
$90.33
|
|
|
HC SBBB FFP PEDS
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.70
|
| Rate for Payer: Heritage Provider Network Senior |
$329.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
|
|
HC SBBB FFP PEDS
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904565
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$260.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.32
|
| Rate for Payer: Blue Shield of California Commercial |
$297.07
|
| Rate for Payer: Blue Shield of California EPN |
$237.66
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cash Price |
$487.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$316.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Senior |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$180.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$301.45
|
| Rate for Payer: Heritage Provider Network Senior |
$301.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$241.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$232.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.01
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$198.19
|
| Rate for Payer: TriValley Medical Group Senior |
$180.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.33 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.81
|
| Rate for Payer: Blue Shield of California Commercial |
$310.49
|
| Rate for Payer: Blue Shield of California EPN |
$248.39
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.36
|
| Rate for Payer: Dignity Health Senior |
$90.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$90.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$90.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.82
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$99.36
|
| Rate for Payer: TriValley Medical Group Senior |
$90.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.36
|
| Rate for Payer: Vantage Medical Group Senior |
$90.33
|
|
|
HC SBBB FFP TO 399 ML
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT P9059
|
| Hospital Charge Code |
900904567
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.55
|
| Rate for Payer: Blue Shield of California Commercial |
$154.33
|
| Rate for Payer: Blue Shield of California EPN |
$123.46
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Senior |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$49.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.61
|
| Rate for Payer: Heritage Provider Network Senior |
$156.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.84
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$54.86
|
| Rate for Payer: TriValley Medical Group Senior |
$49.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC SBBB FREEZE & DEGLYC PROC
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86932
|
| Hospital Charge Code |
900904416
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$189.75 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.28
|
| Rate for Payer: Heritage Provider Network Senior |
$171.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.25
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$931.25 |
| Max. Negotiated Rate |
$3,858.75 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,483.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,483.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.25
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
|
|
HC SBBB GRANULOCYTE APHERESIS
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
CPT P9050
|
| Hospital Charge Code |
900904515
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$526.00 |
| Max. Negotiated Rate |
$4,373.25 |
| Rate for Payer: Adventist Health Commercial |
$1,029.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,750.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,534.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,829.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,858.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,919.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,138.45
|
| Rate for Payer: Blue Shield of California EPN |
$2,510.76
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cash Price |
$5,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,344.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,373.25
|
| Rate for Payer: Dignity Health Senior |
$4,373.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,344.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,184.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,184.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,247.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,454.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,601.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,858.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,373.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,373.25
|
|
