|
HC SOM IRON LIVER TISSUE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$59.13 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.13
|
| Rate for Payer: Blue Shield of California Commercial |
$52.13
|
| Rate for Payer: Blue Shield of California EPN |
$41.81
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.08
|
| Rate for Payer: Heritage Provider Network Senior |
$27.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.71
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$125.25
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Senior |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.76
|
| Rate for Payer: Heritage Provider Network Senior |
$24.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.16
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.11
|
| Rate for Payer: TriValley Medical Group Senior |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$441.49 |
| Rate for Payer: Adventist Health Commercial |
$20.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$441.49
|
| Rate for Payer: Blue Shield of California Commercial |
$62.01
|
| Rate for Payer: Blue Shield of California EPN |
$49.61
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.83
|
| Rate for Payer: Dignity Health Senior |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$91.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.93
|
| Rate for Payer: Heritage Provider Network Senior |
$62.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115.49
|
| Rate for Payer: Multiplan Commercial |
$76.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$91.66
|
| Rate for Payer: TriValley Medical Group Senior |
$91.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$98.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$98.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$76.25 |
| Rate for Payer: Adventist Health Commercial |
$20.33
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.82
|
| Rate for Payer: Heritage Provider Network Senior |
$68.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$76.25
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.66
|
| 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 |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.25
|
| 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 |
$42.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.23
|
| Rate for Payer: Heritage Provider Network Senior |
$40.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| 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 |
$48.75
|
| 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 JC VIRUS BY PCR
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.01
|
| Rate for Payer: Heritage Provider Network Senior |
$44.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.38
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.75
|
| Rate for Payer: Heritage Provider Network Senior |
$9.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.66
|
| Rate for Payer: Heritage Provider Network Senior |
$10.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.13
|
| Rate for Payer: Blue Shield of California Commercial |
$202.00
|
| Rate for Payer: Blue Shield of California EPN |
$162.02
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$33.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.47
|
| Rate for Payer: TriValley Medical Group Senior |
$33.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$36.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.08
|
| Rate for Payer: Heritage Provider Network Senior |
$5.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
|
|
HC SOM KPNRP 87798
|
Facility
|
IP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$118.46 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.93
|
| Rate for Payer: Heritage Provider Network Senior |
$106.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.49
|
| Rate for Payer: Multiplan Commercial |
$118.46
|
|
|
HC SOM KPNRP 87798
|
Facility
|
OP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$310.02 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Aetna of CA Gatekeeper |
$84.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$108.51
|
| 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 |
$310.02
|
| Rate for Payer: Blue Shield of California Commercial |
$282.47
|
| Rate for Payer: Blue Shield of California EPN |
$226.56
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.67
|
| 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 |
$102.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.77
|
| Rate for Payer: Heritage Provider Network Senior |
$97.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$75.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.49
|
| 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 |
$118.46
|
| 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 LACTOFERR DET EIA STOOL
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$157.94 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.10
|
| Rate for Payer: Blue Shield of California Commercial |
$157.94
|
| Rate for Payer: Blue Shield of California EPN |
$126.68
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.67
|
| Rate for Payer: Dignity Health Senior |
$19.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.54
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.56
|
| Rate for Payer: Heritage Provider Network Senior |
$59.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.82
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.70
|
| Rate for Payer: TriValley Medical Group Senior |
$19.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$21.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$21.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Vantage Medical Group Senior |
$19.70
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$72.17 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.14
|
| Rate for Payer: Heritage Provider Network Senior |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.38
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.24
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.75
|
| Rate for Payer: Heritage Provider Network Senior |
$9.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.66
|
| Rate for Payer: Heritage Provider Network Senior |
$10.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.77
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.31
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.86
|
| Rate for Payer: Heritage Provider Network Senior |
$8.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.69
|
| Rate for Payer: Heritage Provider Network Senior |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
|
|
HC SOM LASIX
|
Facility
|
IP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.59 |
| Max. Negotiated Rate |
$89.46 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.75
|
| Rate for Payer: Heritage Provider Network Senior |
$80.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.82
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
|
|
HC SOM LASIX
|
Facility
|
OP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$132.94 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$63.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.94
|
| Rate for Payer: Blue Shield of California Commercial |
$110.19
|
| Rate for Payer: Blue Shield of California EPN |
$88.38
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.83
|
| Rate for Payer: Heritage Provider Network Senior |
$73.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$54.95 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.95
|
| Rate for Payer: Blue Shield of California Commercial |
$48.61
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.04
|
| Rate for Payer: TriValley Medical Group Senior |
$6.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC SOM LD ISOENZYMES
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.66
|
| Rate for Payer: Blue Shield of California Commercial |
$102.99
|
| Rate for Payer: Blue Shield of California EPN |
$82.61
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.07
|
| Rate for Payer: Dignity Health Senior |
$12.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.29
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.79
|
| Rate for Payer: TriValley Medical Group Senior |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Vantage Medical Group Senior |
$12.79
|
|
