|
HC RENAL CYST ASPIRATION
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,255.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,372.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,259.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,737.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| 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 |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
IP
|
$3,650.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.65 |
| Max. Negotiated Rate |
$2,737.50 |
| Rate for Payer: Adventist Health Commercial |
$730.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,350.60
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,471.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,471.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.50
|
| Rate for Payer: Multiplan Commercial |
$2,737.50
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
OP
|
$1,754.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.18 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,083.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.19
|
| Rate for Payer: Blue Shield of California Commercial |
$262.61
|
| Rate for Payer: Blue Shield of California EPN |
$211.18
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,034.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,085.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,085.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$836.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
IP
|
$1,754.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.47 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Adventist Health Commercial |
$350.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,129.58
|
| Rate for Payer: Cash Price |
$789.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,187.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,187.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$317.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.50
|
| Rate for Payer: Multiplan Commercial |
$1,315.50
|
|
|
HC RENAL DILATOR SET
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$459.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$287.03
|
| Rate for Payer: Blue Shield of California EPN |
$287.03
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.58
|
| Rate for Payer: Heritage Provider Network Senior |
$330.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.41
|
|
|
HC RENAL DILATOR SET
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$287.03
|
| Rate for Payer: Blue Shield of California EPN |
$287.03
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$328.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$330.58
|
| Rate for Payer: Heritage Provider Network Senior |
$330.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$357.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$357.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.54 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$361.28
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.80
|
| Rate for Payer: Heritage Provider Network Senior |
$379.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$420.75 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.40
|
| Rate for Payer: Blue Shield of California Commercial |
$69.87
|
| Rate for Payer: Blue Shield of California EPN |
$56.04
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$347.26
|
| Rate for Payer: Heritage Provider Network Senior |
$347.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$267.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.63
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.68
|
| Rate for Payer: TriValley Medical Group Senior |
$8.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$8,169.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$6,126.75 |
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,260.84
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,530.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,478.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$8,169.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,048.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,309.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,056.61
|
| Rate for Payer: Heritage Provider Network Senior |
$8,802.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,598.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,478.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.55
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.55
|
| 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 |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$8,169.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,048.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,309.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,056.61
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,478.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$8,169.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.59 |
| Max. Negotiated Rate |
$6,126.75 |
| Rate for Payer: Adventist Health Commercial |
$1,633.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,260.84
|
| Rate for Payer: Cash Price |
$3,676.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,530.41
|
| Rate for Payer: Heritage Provider Network Senior |
$5,530.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,478.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.25
|
| Rate for Payer: Multiplan Commercial |
$6,126.75
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$486.17 |
| Max. Negotiated Rate |
$2,014.50 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,659.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,343.54
|
| Rate for Payer: Blue Shield of California Commercial |
$938.16
|
| Rate for Payer: Blue Shield of California EPN |
$754.44
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,745.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,745.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$698.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,662.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,662.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,281.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$803.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$768.18
|
| Rate for Payer: TriValley Medical Group Senior |
$698.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,343.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,343.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$486.17 |
| Max. Negotiated Rate |
$2,014.50 |
| Rate for Payer: Adventist Health Commercial |
$537.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,729.78
|
| Rate for Payer: Cash Price |
$1,208.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,818.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,818.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$486.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$671.50
|
| Rate for Payer: Multiplan Commercial |
$2,014.50
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$10,964.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.48 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: Adventist Health Commercial |
$2,192.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,060.82
|
| Rate for Payer: Cash Price |
$4,933.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,422.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,422.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,984.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,741.00
|
| Rate for Payer: Multiplan Commercial |
$8,223.00
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$10,964.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.48 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$2,192.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,775.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,207.90
|
| Rate for Payer: Blue Shield of California EPN |
$4,144.39
|
| Rate for Payer: Cash Price |
$4,933.80
|
| Rate for Payer: Cash Price |
$4,933.80
|
| Rate for Payer: Cash Price |
$4,933.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,126.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,422.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,422.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,229.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,984.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,741.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$8,223.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,578.40
|
| Rate for Payer: TriValley Medical Group Senior |
$6,578.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,055.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,579.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,257.23
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,161.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,251.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,251.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,586.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,995.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.01 |
| Max. Negotiated Rate |
$2,494.50 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,141.94
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,251.70
|
| Rate for Payer: Heritage Provider Network Senior |
$2,251.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$602.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.50
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$11,928.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,158.97 |
| Max. Negotiated Rate |
$8,946.00 |
| Rate for Payer: Adventist Health Commercial |
$2,385.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,681.63
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,075.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8,075.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,158.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,982.00
|
| Rate for Payer: Multiplan Commercial |
$8,946.00
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$11,928.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,158.97 |
| Max. Negotiated Rate |
$16,930.81 |
| Rate for Payer: Adventist Health Commercial |
$2,385.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,371.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,665.80
|
| Rate for Payer: Blue Shield of California EPN |
$4,508.78
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,753.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,753.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$11,287.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,075.26
|
| Rate for Payer: Heritage Provider Network Senior |
$8,075.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,689.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,158.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,980.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,982.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$8,946.00
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.80
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$4,943.25 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,244.60
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,073.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,130.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,491.40
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,284.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,143.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,954.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,954.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
OP
|
$10,980.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,987.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,196.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,785.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,215.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,150.44
|
| Rate for Payer: Cash Price |
$4,941.00
|
| Rate for Payer: Cash Price |
$4,941.00
|
| Rate for Payer: Cash Price |
$4,941.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,137.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,433.46
|
| Rate for Payer: Heritage Provider Network Senior |
$7,433.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,237.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,987.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$8,235.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,588.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6,588.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
