|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.98
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$527.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$405.65
|
| Rate for Payer: Blue Shield of California EPN |
$322.81
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$555.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$407.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$512.40
|
| Rate for Payer: TriValley Medical Group Senior |
$512.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$549.98
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$527.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$555.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.63
|
| Rate for Payer: Heritage Provider Network Senior |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$490.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$283.86
|
| Rate for Payer: TriValley Medical Group Senior |
$283.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.68
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC SIMP REP SUP WND LT 2.5CM FACE
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
900501025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$432.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.36
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$434.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Senior |
$546.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Adventist Health Commercial |
$304.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$723.90
|
| Rate for Payer: Blue Shield of California EPN |
$576.07
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$990.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$258.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,031.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,031.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$726.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$275.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,143.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: TriValley Medical Group Commercial |
$914.40
|
| Rate for Payer: TriValley Medical Group Senior |
$914.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SIMP REP SUP WND OVER 30.0 CM
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
900501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Adventist Health Commercial |
$304.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$981.46
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,031.75
|
| Rate for Payer: Heritage Provider Network Senior |
$1,031.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$275.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.00
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$991.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$761.90
|
| Rate for Payer: Blue Shield of California EPN |
$606.31
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,042.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,085.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,085.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$765.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,203.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$962.40
|
| Rate for Payer: TriValley Medical Group Senior |
$962.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIM REP SUP WND 12.6-20CM FACE
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
900501407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$1,203.00 |
| Rate for Payer: Adventist Health Commercial |
$320.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,032.98
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,085.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,085.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.00
|
| Rate for Payer: Multiplan Commercial |
$1,203.00
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$1,350.75 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,159.84
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,219.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,219.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.25
|
| Rate for Payer: Multiplan Commercial |
$1,350.75
|
|
|
HC SIM REP SUP WND 20.1-30CM FACE
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 12017
|
| Hospital Charge Code |
900501243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$360.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,113.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$855.48
|
| Rate for Payer: Blue Shield of California EPN |
$680.78
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cash Price |
$810.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,170.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,219.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,219.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$859.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,350.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,080.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,080.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,114.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.22
|
| Rate for Payer: Blue Shield of California Commercial |
$222.77
|
| Rate for Payer: Blue Shield of California EPN |
$179.14
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,171.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,063.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,116.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$860.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,352.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: Adventist Health Commercial |
$360.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,161.13
|
| Rate for Payer: Cash Price |
$811.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,220.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,220.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.75
|
| Rate for Payer: Multiplan Commercial |
$1,352.25
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.66 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Adventist Health Commercial |
$172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.84
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.22
|
| Rate for Payer: Heritage Provider Network Senior |
$582.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Adventist Health Commercial |
$172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.82
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.34
|
| Rate for Payer: Heritage Provider Network Senior |
$532.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$410.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$142.85
|
| Rate for Payer: Heritage Provider Network Senior |
$142.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$158.25 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$130.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.46
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California Commercial |
$110.42
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Blue Shield of California EPN |
$88.57
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$137.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.34
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$130.61
|
| Rate for Payer: Heritage Provider Network Senior |
$77.99
|
| Rate for Payer: Heritage Provider Network Senior |
$130.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$60.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: TriValley Medical Group Senior |
$13.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$5,431.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$983.01 |
| Max. Negotiated Rate |
$11,108.00 |
| Rate for Payer: Adventist Health Commercial |
$1,086.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,616.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,987.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,073.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,443.95
|
| Rate for Payer: Cash Price |
$2,443.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,530.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,616.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,616.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,616.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,258.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,361.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,361.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,590.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$983.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,801.70
|
| Rate for Payer: Multiplan Commercial |
$4,073.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,616.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,616.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,616.35
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$5,431.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$983.01 |
| Max. Negotiated Rate |
$4,073.25 |
| Rate for Payer: Adventist Health Commercial |
$1,086.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,497.56
|
| Rate for Payer: Cash Price |
$2,443.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,676.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,676.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$983.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.75
|
| Rate for Payer: Multiplan Commercial |
$4,073.25
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$937.50 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.25
|
| Rate for Payer: Heritage Provider Network Senior |
$846.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$3,765.84 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$772.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$687.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,765.84
|
| Rate for Payer: Blue Shield of California Commercial |
$762.50
|
| Rate for Payer: Blue Shield of California EPN |
$610.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$812.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,062.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,062.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$737.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$773.75
|
| Rate for Payer: Heritage Provider Network Senior |
$773.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$596.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$625.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$625.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,062.50
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$689.72
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$725.07
|
| Rate for Payer: Heritage Provider Network Senior |
$725.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$3,226.27 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$661.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$803.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,226.27
|
| Rate for Payer: Blue Shield of California Commercial |
$653.31
|
| Rate for Payer: Blue Shield of California EPN |
$522.65
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cash Price |
$481.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$696.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$910.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$910.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$631.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.95
|
| Rate for Payer: Heritage Provider Network Senior |
$662.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$510.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$749.70
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$535.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$535.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$910.35
|
| Rate for Payer: Vantage Medical Group Senior |
$910.35
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS 1ST 100 SQ CM
|
Facility
|
OP
|
$11,524.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,085.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,121.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,029.64
|
| Rate for Payer: Blue Shield of California EPN |
$5,623.71
|
| Rate for Payer: Cash Price |
$5,185.80
|
| Rate for Payer: Cash Price |
$5,185.80
|
| Rate for Payer: Cash Price |
$5,185.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,490.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,133.36
|
| Rate for Payer: Heritage Provider Network Senior |
$7,133.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,085.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$8,643.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,919.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,919.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,762.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,762.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
