|
HC UPPER GI ENDOSCOPY W OPTCL END
|
Facility
|
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 43252
|
| Hospital Charge Code |
906743252
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$684.36 |
| Max. Negotiated Rate |
$2,835.75 |
| Rate for Payer: Adventist Health Commercial |
$756.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,597.55
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,559.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,559.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.25
|
| Rate for Payer: Multiplan Commercial |
$2,835.75
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
OP
|
$4,013.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$802.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,756.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,805.85
|
| Rate for Payer: Cash Price |
$1,805.85
|
| Rate for Payer: Cash Price |
$1,805.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,608.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,716.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,716.80
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,934.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,009.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,457.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,340.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC UPPER GI ENDOSCOPY W/RMVL FB
|
Facility
|
IP
|
$4,013.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
900501341
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.35 |
| Max. Negotiated Rate |
$3,009.75 |
| Rate for Payer: Adventist Health Commercial |
$802.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,756.93
|
| Rate for Payer: Cash Price |
$1,805.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,716.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,716.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.25
|
| Rate for Payer: Multiplan Commercial |
$3,009.75
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
OP
|
$6,057.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$56.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,161.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,785.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cash Price |
$2,725.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,937.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,263.53
|
| Rate for Payer: Dignity Health Senior |
$4,785.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,785.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,749.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5,885.59
|
| Rate for Payer: Humana Medicare |
$4,785.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,785.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9,091.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,096.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,646.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,514.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,029.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,029.14
|
| Rate for Payer: Multiplan Commercial |
$4,542.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,177.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,263.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4,785.03
|
|
|
HC UPPER GI SCOPE W/THRMAL ENERGY
|
Facility
|
IP
|
$5,120.00
|
|
|
Service Code
|
CPT 43257
|
| Hospital Charge Code |
906743257
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$926.72 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,517.44
|
| Rate for Payer: Cash Price |
$2,304.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,466.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,466.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$926.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.00
|
| Rate for Payer: Multiplan Commercial |
$3,840.00
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC UREA NITROGEN, UR
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900910460
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE 24 HOURS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.12
|
| Rate for Payer: Dignity Health Senior |
$5.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$5.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.12
|
| Rate for Payer: Vantage Medical Group Senior |
$5.56
|
|
|
HC UREA NITROGEN URINE RANDOM
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
900912195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.11 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.34
|
| Rate for Payer: Heritage Provider Network Senior |
$131.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.50
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$884.37 |
| Max. Negotiated Rate |
$3,664.50 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,307.82
|
| Rate for Payer: Heritage Provider Network Senior |
$3,307.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
|
|
HC URE EMBOLIZATION OR OCCLUSION
|
Facility
|
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 50705
|
| Hospital Charge Code |
909050705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$977.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,356.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,153.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,687.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,664.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,175.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,153.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,153.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,024.43
|
| Rate for Payer: Heritage Provider Network Senior |
$3,024.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,461.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,355.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,221.50
|
| Rate for Payer: Multiplan Commercial |
$3,664.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,153.10
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
OP
|
$10,729.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,941.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,145.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,370.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,828.05
|
| Rate for Payer: Cash Price |
$4,828.05
|
| Rate for Payer: Cash Price |
$4,828.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,973.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,641.25
|
| Rate for Payer: Heritage Provider Network Senior |
$5,357.54
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,031.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,941.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,682.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$8,046.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,791.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URE STNT PLCMNT W NEPH CATH
|
Facility
|
IP
|
$10,729.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
909050695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,941.95 |
| Max. Negotiated Rate |
$8,046.75 |
| Rate for Payer: Adventist Health Commercial |
$2,145.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,370.82
|
| Rate for Payer: Cash Price |
$4,828.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,263.53
|
| Rate for Payer: Heritage Provider Network Senior |
$7,263.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,941.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,682.25
|
| Rate for Payer: Multiplan Commercial |
$8,046.75
|
|
|
HC URETERAL BIOPSY
|
Facility
|
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,743.94 |
| Max. Negotiated Rate |
$7,226.25 |
| Rate for Payer: Adventist Health Commercial |
$1,927.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.24
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,522.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,522.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
|
|
HC URETERAL BIOPSY
|
Facility
|
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 50955
|
| Hospital Charge Code |
909000193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$526.19 |
| Max. Negotiated Rate |
$12,283.52 |
| Rate for Payer: Adventist Health Commercial |
$1,927.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,262.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,964.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7,951.96
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$526.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,283.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.51
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
IP
|
$9,635.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,743.94 |
| Max. Negotiated Rate |
$7,226.25 |
| Rate for Payer: Adventist Health Commercial |
$1,927.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.24
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,522.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,522.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
|
|
HC URETERAL BRUSH BIOPSY
|
Facility
|
OP
|
$9,635.00
|
|
|
Service Code
|
CPT 52007
|
| Hospital Charge Code |
909000173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$771.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,927.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,619.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,355.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cash Price |
$4,335.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,262.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,791.29
|
| Rate for Payer: Dignity Health Senior |
$4,355.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,355.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,964.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5,357.54
|
| Rate for Payer: Humana Medicare |
$4,355.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$771.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,355.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,275.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,743.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,139.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,488.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,488.21
|
| Rate for Payer: Multiplan Commercial |
$7,226.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,791.29
|
| Rate for Payer: TriValley Medical Group Senior |
$4,791.29
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,533.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,791.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4,355.72
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$7,771.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,406.55 |
| Max. Negotiated Rate |
$5,828.25 |
| Rate for Payer: Adventist Health Commercial |
$1,554.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,338.68
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,260.97
|
| Rate for Payer: Heritage Provider Network Senior |
$5,260.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,406.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,942.75
|
| Rate for Payer: Multiplan Commercial |
$5,828.25
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$7,771.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,554.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,338.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,051.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,260.97
|
| Rate for Payer: Heritage Provider Network Senior |
$5,260.97
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,745.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,406.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,942.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$5,828.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,821.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,596.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL DILATION
|
Facility
|
OP
|
$7,771.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,554.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,338.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,051.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,810.25
|
| Rate for Payer: Heritage Provider Network Senior |
$379.81
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$586.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,406.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,942.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$5,828.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$339.67
|
| Rate for Payer: TriValley Medical Group Senior |
$339.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC URETERAL DILATION
|
Facility
|
IP
|
$7,771.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
909000174
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,406.55 |
| Max. Negotiated Rate |
$5,828.25 |
| Rate for Payer: Adventist Health Commercial |
$1,554.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,338.68
|
| Rate for Payer: Cash Price |
$3,496.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,260.97
|
| Rate for Payer: Heritage Provider Network Senior |
$5,260.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,406.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,942.75
|
| Rate for Payer: Multiplan Commercial |
$5,828.25
|
|
|
HC URETERAL STENT KIT
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.84
|
| Rate for Payer: Heritage Provider Network Senior |
$513.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
|
|
HC URETERAL STENT KIT
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT C2617
|
| Hospital Charge Code |
909001064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$471.34
|
| Rate for Payer: Blue Shield of California EPN |
$445.53
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$645.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$645.15
|
| Rate for Payer: Dignity Health Senior |
$645.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.42
|
| Rate for Payer: Heritage Provider Network Senior |
$351.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$276.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$253.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Vantage Medical Group Senior |
$645.15
|
|
