|
HC SKIN SUB GRAFT TRUNK ARMS LEGS 1ST 100 SQ CM
|
Facility
|
IP
|
$11,524.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,085.84 |
| Max. Negotiated Rate |
$8,643.00 |
| Rate for Payer: Adventist Health Commercial |
$2,304.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,421.46
|
| Rate for Payer: Cash Price |
$5,185.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,801.75
|
| Rate for Payer: Heritage Provider Network Senior |
$7,801.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,085.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,881.00
|
| Rate for Payer: Multiplan Commercial |
$8,643.00
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$5,098.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,019.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,150.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,333.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,803.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,823.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,109.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,487.82
|
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,313.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,333.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,333.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,333.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,155.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,155.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,431.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$922.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,568.60
|
| Rate for Payer: Multiplan Commercial |
$3,823.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,549.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,549.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,549.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,549.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,333.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,333.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4,333.30
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$5,098.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.74 |
| Max. Negotiated Rate |
$3,823.50 |
| Rate for Payer: Adventist Health Commercial |
$1,019.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,283.11
|
| Rate for Payer: Cash Price |
$2,294.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,451.35
|
| Rate for Payer: Heritage Provider Network Senior |
$3,451.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$922.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,274.50
|
| Rate for Payer: Multiplan Commercial |
$3,823.50
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$2,294.25 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,970.00
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,070.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,070.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,890.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,294.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,865.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,492.79
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,988.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,600.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,600.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,893.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,459.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,529.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,529.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,529.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,529.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,692.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,657.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,126.22
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,832.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,696.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,696.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,078.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,045.63
|
| Rate for Payer: TriValley Medical Group Senior |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,178.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$3,267.75 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,805.91
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,692.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,069.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,646.95
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,832.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,078.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,614.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,614.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$3,267.75 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,805.91
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,949.69
|
| Rate for Payer: Heritage Provider Network Senior |
$2,949.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$788.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.25
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
OP
|
$6,118.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,107.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,780.92
|
| 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 |
$3,731.98
|
| Rate for Payer: Blue Shield of California EPN |
$2,985.58
|
| Rate for Payer: Cash Price |
$2,753.10
|
| Rate for Payer: Cash Price |
$2,753.10
|
| Rate for Payer: Cash Price |
$2,753.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,976.70
|
| 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 |
$3,787.04
|
| Rate for Payer: Heritage Provider Network Senior |
$3,787.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,918.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,107.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,588.50
|
| 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 |
$3,059.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,059.00
|
| 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
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
IP
|
$6,118.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,107.36 |
| Max. Negotiated Rate |
$4,588.50 |
| Rate for Payer: Adventist Health Commercial |
$1,223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,939.99
|
| Rate for Payer: Cash Price |
$2,753.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,141.89
|
| Rate for Payer: Heritage Provider Network Senior |
$4,141.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,107.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,529.50
|
| Rate for Payer: Multiplan Commercial |
$4,588.50
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,890.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,294.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,865.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,492.79
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,988.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,600.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,600.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,893.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,459.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,529.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,529.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,529.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,529.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$2,294.25 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,970.00
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,070.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,070.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$2,294.25 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,970.00
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,070.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,070.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,890.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,294.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,865.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,492.79
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,988.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,600.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,600.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,893.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,893.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,459.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$553.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,529.50
|
| Rate for Payer: TriValley Medical Group Senior |
$1,529.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,529.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,529.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.85
|
| Rate for Payer: Blue Shield of California Commercial |
$160.43
|
| Rate for Payer: Blue Shield of California EPN |
$128.34
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$125.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$105.20
|
| Rate for Payer: TriValley Medical Group Senior |
$105.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.37
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.08
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$464.97
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$488.79
|
| Rate for Payer: Heritage Provider Network Senior |
$488.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.50
|
| Rate for Payer: Multiplan Commercial |
$541.50
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$541.50 |
| Rate for Payer: Adventist Health Commercial |
$144.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.99
|
| Rate for Payer: Blue Shield of California Commercial |
$188.45
|
| Rate for Payer: Blue Shield of California EPN |
$151.54
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cash Price |
$324.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$469.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.92
|
| Rate for Payer: Heritage Provider Network Senior |
$446.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$344.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$541.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SKULL LIMITED
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$755.41
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.12
|
| Rate for Payer: Heritage Provider Network Senior |
$794.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$724.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.88
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$762.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$726.09
|
| Rate for Payer: Heritage Provider Network Senior |
$726.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$559.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$325.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.95
|
| Rate for Payer: Blue Shield of California Commercial |
$174.58
|
| Rate for Payer: Blue Shield of California Commercial |
$174.58
|
| Rate for Payer: Blue Shield of California EPN |
$140.39
|
| Rate for Payer: Blue Shield of California EPN |
$140.39
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$67.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.21
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$326.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$251.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: TriValley Medical Group Senior |
$67.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$395.25 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$339.39
|
| Rate for Payer: Cash Price |
$237.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$356.78
|
| Rate for Payer: Heritage Provider Network Senior |
$356.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.75
|
| Rate for Payer: Multiplan Commercial |
$395.25
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
|
IP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Senior |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.91
|
|
|
HC SLING ARM PED PRINT CHILD
|
Facility
|
OP
|
$14.82
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901698366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$6.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5.96
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cash Price |
$6.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.86
|
| Rate for Payer: Heritage Provider Network Senior |
$6.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
