|
HC SOM ENC PDE10A IFA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.57
|
| Rate for Payer: Heritage Provider Network Senior |
$23.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC PDE10A IFA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915482
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.55 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.77
|
| Rate for Payer: Heritage Provider Network Senior |
$25.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
|
|
HC SOM ENC SEPTIN7 IFA
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.55 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.77
|
| Rate for Payer: Heritage Provider Network Senior |
$25.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
|
|
HC SOM ENC SEPTIN7 IFA
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915480
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.57
|
| Rate for Payer: Heritage Provider Network Senior |
$23.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC TRIM46 IFA
|
Facility
|
OP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.74
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.56
|
| Rate for Payer: Heritage Provider Network Senior |
$23.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENC TRIM46 IFA
|
Facility
|
IP
|
$38.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915481
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.55 |
| Rate for Payer: Adventist Health Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$38.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.77
|
| Rate for Payer: Heritage Provider Network Senior |
$25.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.52
|
| Rate for Payer: Multiplan Commercial |
$28.55
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$69.64 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.10
|
| Rate for Payer: Blue Shield of California Commercial |
$69.64
|
| Rate for Payer: Blue Shield of California EPN |
$55.86
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.23
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.09
|
| Rate for Payer: TriValley Medical Group Senior |
$12.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM ENDOMYSIAL IGA AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
900911423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS DPPX CBA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC SOM ENS IGLON5 CBA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC SOM ENS IGLON5 CBA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC SOM ENS NEUROCHONDRIN IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915476
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC SOM ENS PDE10A IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
OP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.28
|
| Rate for Payer: Heritage Provider Network Senior |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
IP
|
$44.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$44.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.05
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
OP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$110.08 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.08
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.80
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.29
|
| Rate for Payer: Heritage Provider Network Senior |
$27.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Senior |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
IP
|
$44.08
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$33.06 |
| Rate for Payer: Adventist Health Commercial |
$8.82
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.84
|
| Rate for Payer: Heritage Provider Network Senior |
$29.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$33.06
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
OP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$313.46 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.46
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$29.42 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.56
|
| Rate for Payer: Heritage Provider Network Senior |
$26.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$29.42 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.56
|
| Rate for Payer: Heritage Provider Network Senior |
$26.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
OP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$313.46 |
| Rate for Payer: Adventist Health Commercial |
$7.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.46
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cash Price |
$39.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.28
|
| Rate for Payer: Heritage Provider Network Senior |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$29.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$170.38 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| Rate for Payer: Blue Shield of California Commercial |
$151.26
|
| Rate for Payer: Blue Shield of California EPN |
$121.32
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.67
|
| Rate for Payer: Dignity Health Senior |
$18.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.71
|
| Rate for Payer: Heritage Provider Network Senior |
$9.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$11.76
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.79
|
| Rate for Payer: TriValley Medical Group Senior |
$18.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Vantage Medical Group Senior |
$18.79
|
|
