|
HC SOM FMGA 84181
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$142.57 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.57
|
| Rate for Payer: Blue Shield of California Commercial |
$133.04
|
| Rate for Payer: Blue Shield of California EPN |
$104.01
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Senior |
$17.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$17.03
|
| Rate for Payer: IEHP Medi-Cal |
$23.62
|
| Rate for Payer: IEHP Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.03
|
| Rate for Payer: TriValley Medical Group Senior |
$17.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM FMGS 83520A
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| 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 |
$82.50
|
| 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 |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520A
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC SOM FMGS 83520B
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.09
|
| Rate for Payer: Heritage Provider Network Senior |
$68.09
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| 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 |
$82.50
|
| 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 |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520B
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.57
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.47
|
| Rate for Payer: Heritage Provider Network Senior |
$74.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
|
|
HC SOM FMIS 83520
|
Facility
OP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$133.30 |
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.01
|
| Rate for Payer: Heritage Provider Network Senior |
$110.01
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.43
|
| 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 |
$133.30
|
| 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 |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMIS 83520
|
Facility
IP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$133.30 |
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.10
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.32
|
| Rate for Payer: Heritage Provider Network Senior |
$120.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.43
|
| Rate for Payer: Multiplan Commercial |
$133.30
|
|
|
HC SOM FNTSM
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| 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 FNTSM
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492A
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492A
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| 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 FNTSM 82492B
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492B
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| 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 FOLATE, RBC
|
Facility
IP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$39.38 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.07
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.54
|
| Rate for Payer: Heritage Provider Network Senior |
$35.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
|
|
HC SOM FOLATE, RBC
|
Facility
OP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$150.29 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.29
|
| Rate for Payer: Blue Shield of California Commercial |
$135.28
|
| Rate for Payer: Blue Shield of California EPN |
$105.75
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.42
|
| Rate for Payer: Dignity Health Senior |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.50
|
| Rate for Payer: Heritage Provider Network Senior |
$32.50
|
| Rate for Payer: Humana Medicare |
$17.65
|
| Rate for Payer: IEHP Medi-Cal |
$17.92
|
| Rate for Payer: IEHP Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.24
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.65
|
| Rate for Payer: TriValley Medical Group Senior |
$17.65
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC SOM FPRSG 84150
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$72.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.89
|
| Rate for Payer: Blue Shield of California Commercial |
$194.98
|
| Rate for Payer: Blue Shield of California EPN |
$152.43
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.95
|
| Rate for Payer: Dignity Health Senior |
$41.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.65
|
| Rate for Payer: Heritage Provider Network Senior |
$216.65
|
| Rate for Payer: Humana Medicare |
$41.77
|
| Rate for Payer: IEHP Medi-Cal |
$42.39
|
| Rate for Payer: IEHP Medicare Advantage |
$41.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.63
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.77
|
| Rate for Payer: TriValley Medical Group Senior |
$41.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC SOM FPRSG 84150
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
|
|
HC SOM FPSAP 84153
|
Facility
IP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$67.12 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.49
|
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.59
|
| Rate for Payer: Heritage Provider Network Senior |
$60.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.38
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
|
|
HC SOM FPSAP 84153
|
Facility
OP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.95
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$112.31
|
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.40
|
| Rate for Payer: Heritage Provider Network Senior |
$55.40
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: IEHP Medi-Cal |
$25.51
|
| Rate for Payer: IEHP Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.17
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.39
|
| Rate for Payer: TriValley Medical Group Senior |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM FQUET 82491
|
Facility
IP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$49.62 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.45
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.79
|
| Rate for Payer: Heritage Provider Network Senior |
$44.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.54
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
|
|
HC SOM FQUET 82491
|
Facility
OP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.95
|
| Rate for Payer: Heritage Provider Network Senior |
$40.95
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
IP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$162.38 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.74
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.57
|
| Rate for Payer: Heritage Provider Network Senior |
$146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
OP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$164.54 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.54
|
| Rate for Payer: Blue Shield of California Commercial |
$134.45
|
| Rate for Payer: Blue Shield of California EPN |
$127.09
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$140.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.38
|
| Rate for Payer: Dignity Health Senior |
$44.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.01
|
| Rate for Payer: Heritage Provider Network Senior |
$134.01
|
| Rate for Payer: Humana Medicare |
$44.89
|
| Rate for Payer: IEHP Medi-Cal |
$56.02
|
| Rate for Payer: IEHP Medicare Advantage |
$44.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.56
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: TriValley Medical Group Commercial |
$44.89
|
| Rate for Payer: TriValley Medical Group Senior |
$44.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Vantage Medical Group Senior |
$44.89
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.15
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.65
|
| Rate for Payer: Heritage Provider Network Senior |
$304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$409.62 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$409.62
|
| Rate for Payer: Blue Shield of California Commercial |
$279.45
|
| Rate for Payer: Blue Shield of California EPN |
$264.15
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$292.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.74
|
| Rate for Payer: Dignity Health Senior |
$57.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$57.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.55
|
| Rate for Payer: Heritage Provider Network Senior |
$278.55
|
| Rate for Payer: Humana Medicare |
$57.04
|
| Rate for Payer: IEHP Medi-Cal |
$71.18
|
| Rate for Payer: IEHP Medicare Advantage |
$57.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.87
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$57.04
|
| Rate for Payer: TriValley Medical Group Senior |
$57.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$61.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$61.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Vantage Medical Group Senior |
$57.04
|
|
