|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GASTRIN
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.15
|
| Rate for Payer: Heritage Provider Network Senior |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM GASTRIN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$161.03 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.03
|
| Rate for Payer: Blue Shield of California Commercial |
$141.93
|
| Rate for Payer: Blue Shield of California EPN |
$113.84
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.39
|
| Rate for Payer: Dignity Health Senior |
$17.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.29
|
| Rate for Payer: Heritage Provider Network Senior |
$9.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.21
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.63
|
| Rate for Payer: TriValley Medical Group Senior |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Vantage Medical Group Senior |
$17.63
|
|
|
HC SOM GHIVR 87901
|
Facility
|
OP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$2,348.81 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$197.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$253.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,348.81
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.81
|
| Rate for Payer: Blue Shield of California EPN |
$1,661.77
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$239.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$257.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.24
|
| Rate for Payer: Heritage Provider Network Senior |
$228.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$296.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.39
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$257.45
|
| Rate for Payer: TriValley Medical Group Senior |
$257.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$278.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM GHIVR 87901
|
Facility
|
IP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$276.55 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$249.63
|
| Rate for Payer: Heritage Provider Network Senior |
$249.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.18
|
| Rate for Payer: Multiplan Commercial |
$276.55
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.57
|
| Rate for Payer: Heritage Provider Network Senior |
$15.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$85.13 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.13
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM GLUCAGON
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.73
|
| Rate for Payer: Heritage Provider Network Senior |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
|
|
HC SOM GLUCAGON
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$115.03 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.76
|
| Rate for Payer: Blue Shield of California Commercial |
$115.03
|
| Rate for Payer: Blue Shield of California EPN |
$92.26
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.72
|
| Rate for Payer: Dignity Health Senior |
$14.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.52
|
| Rate for Payer: Heritage Provider Network Senior |
$23.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Senior |
$14.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Vantage Medical Group Senior |
$14.29
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
IP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.33
|
| Rate for Payer: Heritage Provider Network Senior |
$15.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
OP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$88.51 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.51
|
| Rate for Payer: Blue Shield of California Commercial |
$78.05
|
| Rate for Payer: Blue Shield of California EPN |
$62.60
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.67
|
| Rate for Payer: Dignity Health Senior |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.01
|
| Rate for Payer: Heritage Provider Network Senior |
$14.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.22
|
| Rate for Payer: Multiplan Commercial |
$16.98
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.70
|
| Rate for Payer: TriValley Medical Group Senior |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.70
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$140.38 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.38
|
| Rate for Payer: Blue Shield of California Commercial |
$133.75
|
| Rate for Payer: Blue Shield of California EPN |
$107.28
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.08
|
| Rate for Payer: Heritage Provider Network Senior |
$17.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.70
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.69
|
| Rate for Payer: Heritage Provider Network Senior |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$20.70
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
IP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.53
|
| Rate for Payer: Heritage Provider Network Senior |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
OP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.12
|
| Rate for Payer: Blue Shield of California Commercial |
$134.15
|
| Rate for Payer: Blue Shield of California EPN |
$107.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.34
|
| Rate for Payer: Dignity Health Senior |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.19
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.67
|
| Rate for Payer: TriValley Medical Group Senior |
$16.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Vantage Medical Group Senior |
$16.67
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$132.82 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.82
|
| Rate for Payer: Blue Shield of California Commercial |
$117.16
|
| Rate for Payer: Blue Shield of California EPN |
$93.97
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.36
|
| Rate for Payer: Dignity Health Senior |
$15.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.88
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.78
|
| Rate for Payer: TriValley Medical Group Senior |
$15.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Vantage Medical Group Senior |
$15.78
|
|
|
HC SOM HANDLING FEE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Heritage Provider Network Senior |
$23.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
|
|
HC SOM HANDLING FEE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$89.55 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.55
|
| Rate for Payer: Blue Shield of California Commercial |
$21.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.08
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Senior |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.77 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.43
|
| Rate for Payer: Heritage Provider Network Senior |
$114.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.26
|
| Rate for Payer: Multiplan Commercial |
$126.77
|
|
|
HC SOM HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$126.77 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.82
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.86
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.62
|
| Rate for Payer: Heritage Provider Network Senior |
$104.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$126.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM HBEL VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.82
|
| Rate for Payer: Blue Shield of California Commercial |
$103.62
|
| Rate for Payer: Blue Shield of California EPN |
$83.11
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.33
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.87
|
| Rate for Payer: TriValley Medical Group Senior |
$12.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM HBEL VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.68
|
| Rate for Payer: Heritage Provider Network Senior |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$9.62
|
|
|
HC SOM HBEL VARIANT B
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
900915459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$164.17 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.17
|
| Rate for Payer: Blue Shield of California Commercial |
$145.32
|
| Rate for Payer: Blue Shield of California EPN |
$116.56
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Senior |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.76
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.06
|
| Rate for Payer: TriValley Medical Group Senior |
$18.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
