|
HC SKULL COMPLETE
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.16 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$385.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$496.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.60
|
| Rate for Payer: Blue Shield of California Commercial |
$188.45
|
| Rate for Payer: Blue Shield of California EPN |
$151.54
|
| Rate for Payer: Cash Price |
$397.10
|
| Rate for Payer: Cash Price |
$397.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.92
|
| Rate for Payer: Heritage Provider Network Senior |
$446.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$344.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$541.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$397.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$488.79
|
| Rate for Payer: Heritage Provider Network Senior |
$488.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.50
|
| Rate for Payer: Multiplan Commercial |
$541.50
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$626.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.39
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$762.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$726.09
|
| Rate for Payer: Heritage Provider Network Senior |
$726.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$559.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SKULL LIMITED
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.12
|
| Rate for Payer: Heritage Provider Network Senior |
$794.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
|
OP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$6.08
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
| Rate for Payer: Dignity Health Senior |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Senior |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
|
IP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Senior |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.91
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$4,915.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$889.62 |
| Max. Negotiated Rate |
$3,686.25 |
| Rate for Payer: Adventist Health Commercial |
$983.00
|
| Rate for Payer: Cash Price |
$2,703.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,327.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$889.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.75
|
| Rate for Payer: Multiplan Commercial |
$3,686.25
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$4,915.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$983.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,376.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,703.25
|
| Rate for Payer: Cash Price |
$2,703.25
|
| Rate for Payer: Cash Price |
$2,703.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,194.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,327.45
|
| Rate for Payer: Heritage Provider Network Senior |
$3,327.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,344.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$889.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$3,686.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,768.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,627.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$86.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.82
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$38.72
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$105.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$77.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.57
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,314.91 |
| Max. Negotiated Rate |
$26,385.49 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16,149.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,757.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18,430.54
|
| Rate for Payer: Blue Shield of California EPN |
$14,744.43
|
| Rate for Payer: Cash Price |
$16,617.70
|
| Rate for Payer: Cash Price |
$16,617.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,639.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,746.40
|
| Rate for Payer: Dignity Health Senior |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,336.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,314.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,702.47
|
| Rate for Payer: Heritage Provider Network Senior |
$18,702.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,385.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,314.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,412.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,468.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,962.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,553.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,436.79
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,746.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,314.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,916.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,003.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,393.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,746.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4,746.40
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$30,214.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,468.73 |
| Max. Negotiated Rate |
$22,660.50 |
| Rate for Payer: Adventist Health Commercial |
$6,042.80
|
| Rate for Payer: Cash Price |
$16,617.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,315.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,454.88
|
| Rate for Payer: Heritage Provider Network Senior |
$20,454.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,468.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,553.50
|
| Rate for Payer: Multiplan Commercial |
$22,660.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,916.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,003.86
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.78
|
| Rate for Payer: Heritage Provider Network Senior |
$880.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$695.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.38
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$845.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.32
|
| Rate for Payer: Heritage Provider Network Senior |
$805.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$153.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$620.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$699.29 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$699.29
|
| Rate for Payer: Blue Shield of California Commercial |
$275.40
|
| Rate for Payer: Blue Shield of California EPN |
$275.40
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$444.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.00
|
| Rate for Payer: TriValley Medical Group Senior |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| 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 |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| 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 |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| 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 |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| 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 |
$49.50
|
| 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 SMIC/ID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.56
|
| Rate for Payer: Heritage Provider Network Senior |
$200.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$154.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.35
|
| Rate for Payer: Heritage Provider Network Senior |
$219.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.84
|
| Rate for Payer: Aetna of CA Gatekeeper |
$173.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$210.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$200.56
|
| Rate for Payer: Heritage Provider Network Senior |
$200.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$154.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.64 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$64.80
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.35
|
| Rate for Payer: Heritage Provider Network Senior |
$219.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$243.00
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$56.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.85
|
| Rate for Payer: Blue Shield of California Commercial |
$84.18
|
| Rate for Payer: Blue Shield of California EPN |
$67.34
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$89.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.63
|
| Rate for Payer: Dignity Health Senior |
$37.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.42
|
| Rate for Payer: Heritage Provider Network Senior |
$85.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.69
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.63
|
| Rate for Payer: TriValley Medical Group Senior |
$37.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$158.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.63
|
| Rate for Payer: Vantage Medical Group Senior |
$37.85
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.28
|
| Rate for Payer: Heritage Provider Network Senior |
$62.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$69.00
|
|
