|
HC SOM MERCURY BLOOD
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$147.76 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$11.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.76
|
| Rate for Payer: Blue Shield of California Commercial |
$130.87
|
| Rate for Payer: Blue Shield of California EPN |
$104.97
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Senior |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.26
|
| Rate for Payer: TriValley Medical Group Senior |
$16.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM MERCURY BLOOD
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM META 1-10
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$1,734.73 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,734.73
|
| Rate for Payer: Blue Shield of California Commercial |
$258.57
|
| Rate for Payer: Blue Shield of California EPN |
$207.39
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$34.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.86
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$34.81
|
| Rate for Payer: TriValley Medical Group Senior |
$34.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM META 1-10
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM META 1-19
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META 1-19
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,132.82 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 1-20
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.47
|
| Rate for Payer: Heritage Provider Network Senior |
$118.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM META 1-20
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,137.86 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,137.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.33
|
| Rate for Payer: Heritage Provider Network Senior |
$108.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META 1-25
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META 1-25
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,315.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,315.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.96
|
| Rate for Payer: Blue Shield of California EPN |
$960.87
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Senior |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$245.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.19
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.17
|
| Rate for Payer: TriValley Medical Group Senior |
$173.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META 20-25
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,132.82 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$93.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.33
|
| Rate for Payer: Heritage Provider Network Senior |
$108.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 20-25
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.47
|
| Rate for Payer: Heritage Provider Network Senior |
$118.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$152.87 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.33
|
| Rate for Payer: Blue Shield of California Commercial |
$152.87
|
| Rate for Payer: Blue Shield of California EPN |
$122.61
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.40
|
| Rate for Payer: Heritage Provider Network Senior |
$7.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
OP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$1,641.19 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,641.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,160.41
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.98
|
| Rate for Payer: Heritage Provider Network Senior |
$69.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$53.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
IP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$84.79 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.53
|
| Rate for Payer: Heritage Provider Network Senior |
$76.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$1,137.86 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,137.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.43
|
| Rate for Payer: Heritage Provider Network Senior |
$73.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
OP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$152.87 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.33
|
| Rate for Payer: Blue Shield of California Commercial |
$152.87
|
| Rate for Payer: Blue Shield of California EPN |
$122.61
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.20
|
| Rate for Payer: Heritage Provider Network Senior |
$11.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.43
|
| Rate for Payer: Heritage Provider Network Senior |
$73.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$1,132.82 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,132.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.05
|
| Rate for Payer: Blue Shield of California EPN |
$804.53
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$187.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$152.87 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.33
|
| Rate for Payer: Blue Shield of California Commercial |
$152.87
|
| Rate for Payer: Blue Shield of California EPN |
$122.61
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
OP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$1,315.00 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,315.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.96
|
| Rate for Payer: Blue Shield of California EPN |
$960.87
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Senior |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.62
|
| Rate for Payer: Heritage Provider Network Senior |
$68.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$245.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$199.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.19
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.17
|
| Rate for Payer: TriValley Medical Group Senior |
$173.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
