|
HC SOM HOMOCYSTEINE
|
Facility
|
OP
|
$17.92
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
900911404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.90
|
| Rate for Payer: Blue Shield of California Commercial |
$135.76
|
| Rate for Payer: Blue Shield of California EPN |
$108.89
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.71
|
| Rate for Payer: Dignity Health Senior |
$17.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.09
|
| Rate for Payer: Heritage Provider Network Senior |
$11.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$13.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.92
|
| Rate for Payer: TriValley Medical Group Senior |
$17.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Vantage Medical Group Senior |
$17.92
|
|
|
HC SOM HPV
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$275.10 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.32
|
| Rate for Payer: Blue Shield of California Commercial |
$275.10
|
| Rate for Payer: Blue Shield of California EPN |
$220.65
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM HPV
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900915272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.80
|
| Rate for Payer: Heritage Provider Network Senior |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
|
|
HC SOM HROMOSOME ANALYSIS AMNIO
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910739
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$213.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$274.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.56
|
| Rate for Payer: Blue Shield of California Commercial |
$37.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.95
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Senior |
$340.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$247.60
|
| Rate for Payer: Heritage Provider Network Senior |
$247.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
OP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.17
|
| Rate for Payer: Heritage Provider Network Senior |
$19.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV 1 AB IGM IFA
|
Facility
|
IP
|
$30.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Adventist Health Commercial |
$6.19
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.97
|
| Rate for Payer: Heritage Provider Network Senior |
$20.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.74
|
| Rate for Payer: Multiplan Commercial |
$23.23
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
OP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Aetna of CA Gatekeeper |
$24.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.13
|
| Rate for Payer: Heritage Provider Network Senior |
$28.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV 2 AB IGM IFA
|
Facility
|
IP
|
$45.45
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$34.09 |
| Rate for Payer: Adventist Health Commercial |
$9.09
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.77
|
| Rate for Payer: Heritage Provider Network Senior |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.36
|
| Rate for Payer: Multiplan Commercial |
$34.09
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.78
|
| Rate for Payer: Heritage Provider Network Senior |
$10.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
|
|
HC SOM HSV AB SCREEN, IGM,S EIA
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900914087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$130.98 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.98
|
| Rate for Payer: Blue Shield of California Commercial |
$115.83
|
| Rate for Payer: Blue Shield of California EPN |
$92.91
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.85
|
| Rate for Payer: Heritage Provider Network Senior |
$9.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.13
|
| Rate for Payer: Multiplan Commercial |
$11.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$8.81 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.95
|
| Rate for Payer: Heritage Provider Network Senior |
$7.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
|
|
HC SOM HSV TYPE 1 AB, IGG, S
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900914085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$2.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$8.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
OP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.68
|
| Rate for Payer: Heritage Provider Network Senior |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HSV TYPE 2 AB, IGG, S
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$12.94 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.68
|
| Rate for Payer: Heritage Provider Network Senior |
$11.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
|
|
HC SOM HTGFN 84432
|
Facility
|
OP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$149.54 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$87.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$112.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.54
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$106.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.67
|
| Rate for Payer: Dignity Health Senior |
$16.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.44
|
| Rate for Payer: Heritage Provider Network Senior |
$101.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$78.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.06
|
| Rate for Payer: TriValley Medical Group Senior |
$16.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.67
|
| Rate for Payer: Vantage Medical Group Senior |
$16.06
|
|
|
HC SOM HTGFN 84432
|
Facility
|
IP
|
$163.88
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
900914871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$122.91 |
| Rate for Payer: Adventist Health Commercial |
$32.78
|
| Rate for Payer: Cash Price |
$163.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.95
|
| Rate for Payer: Heritage Provider Network Senior |
$110.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.97
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC SOM HTLV AB CONFIRM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912880
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$176.71 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$69.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.71
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$62.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.72
|
| Rate for Payer: Heritage Provider Network Senior |
$8.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
|
|
HC SOM HTLV AB SCREEN
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$2.58
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.97
|
| Rate for Payer: Heritage Provider Network Senior |
$7.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$9.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SOM HUMAN HERPESVIRUS-6 PCR
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 87533
|
| Hospital Charge Code |
900912711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$335.98 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$106.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.20
|
| Rate for Payer: Blue Shield of California Commercial |
$335.98
|
| Rate for Payer: Blue Shield of California EPN |
$269.48
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.94
|
| Rate for Payer: Dignity Health Senior |
$41.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.76
|
| Rate for Payer: TriValley Medical Group Senior |
$41.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: Vantage Medical Group Senior |
$41.76
|
|
|
HC SOM HYPOGLYCEMIC AGENT SCREEN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
900912528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC SOM HYPOGLYCEMIC AGENT SCREEN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 80377
|
| Hospital Charge Code |
900912528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$189.37 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.37
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
