|
HC STREPTOCARD STREP A
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
900912483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOCARD STREP B
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912484
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOCARD STREP C
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912485
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOCARD STREP D
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP F
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOCARD STREP F
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912487
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP G
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912488
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.42 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STREPTOCARD STREP G
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912488
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC STREPTOZYME TEST
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86063
|
| Hospital Charge Code |
900910870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.41
|
| Rate for Payer: Blue Shield of California Commercial |
$45.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.27
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.35
|
| Rate for Payer: Dignity Health Senior |
$5.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.27
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.77
|
| Rate for Payer: TriValley Medical Group Senior |
$5.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.35
|
| Rate for Payer: Vantage Medical Group Senior |
$5.77
|
|
|
HC STREPTOZYME TEST
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86063
|
| Hospital Charge Code |
900910870
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
905358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.69
|
|
|
HC STUMP SOCK SINGLE PLY AK EACH
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT L8480
|
| Hospital Charge Code |
905358480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.74
|
| Rate for Payer: Blue Shield of California EPN |
$20.54
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Senior |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.20
|
| Rate for Payer: Heritage Provider Network Senior |
$16.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
905358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.69
|
|
|
HC STUMP SOCK SINGLE PLY BK EACH
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT L8470
|
| Hospital Charge Code |
905358470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.87
|
| Rate for Payer: Blue Shield of California EPN |
$18.78
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.20
|
| Rate for Payer: Dignity Health Senior |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.82
|
| Rate for Payer: Heritage Provider Network Senior |
$14.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.20
|
| Rate for Payer: Vantage Medical Group Senior |
$27.20
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
905358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.82
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.70
|
|
|
HC STUMP SOCK SNGLE PLY UPPER LMB
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L8485
|
| Hospital Charge Code |
905358485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.19
|
| Rate for Payer: Blue Shield of California EPN |
$27.59
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Senior |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.76
|
| Rate for Payer: Heritage Provider Network Senior |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.75
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.51 |
| Max. Negotiated Rate |
$1,535.25 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,406.29
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,385.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,385.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.75
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
|
|
HC STYE INCISION OF LID MARGIN
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT 67830
|
| Hospital Charge Code |
900501664
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.51 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,406.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cash Price |
$921.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,330.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: Dignity Health Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,264.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,385.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,385.82
|
| Rate for Payer: Humana Medicare |
$1,264.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$986.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,492.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,593.86
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$743.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$683.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC SUBC THER INFUSION EA ADD HR
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
907296370
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC SUBC THER INFUSION EA ADD HR
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
907296370
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.28
|
| Rate for Payer: Dignity Health Senior |
$59.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$59.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Humana Medicare |
$59.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$59.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$112.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.78
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.28
|
| Rate for Payer: TriValley Medical Group Senior |
$59.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.28
|
| Rate for Payer: Vantage Medical Group Senior |
$59.35
|
|
|
HC SUBC THER INFUSION UP TO 1 HR
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
907296369
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$117.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$403.96
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$398.08
|
| Rate for Payer: Heritage Provider Network Senior |
$398.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$441.00
|
|
|
HC SUBC THER INFUSION UP TO 1 HR
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
907296369
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Adventist Health Commercial |
$117.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$410.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$403.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$382.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: Dignity Health Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$363.97
|
| Rate for Payer: Heritage Provider Network Senior |
$363.97
|
| Rate for Payer: Humana Medicare |
$267.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$215.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$508.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$316.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.43
|
| Rate for Payer: Multiplan Commercial |
$441.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.58
|
| Rate for Payer: TriValley Medical Group Senior |
$267.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$596.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$501.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
