|
HC SOM TTFB 84402B
|
Facility
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$217.68 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.68
|
| Rate for Payer: Blue Shield of California Commercial |
$198.84
|
| Rate for Payer: Blue Shield of California EPN |
$155.44
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.20
|
| Rate for Payer: Heritage Provider Network Senior |
$50.20
|
| Rate for Payer: Humana Medicare |
$25.47
|
| Rate for Payer: IEHP Medi-Cal |
$35.32
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.09
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.47
|
| Rate for Payer: TriValley Medical Group Senior |
$25.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TTFB 84403
|
Facility
IP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.49
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.67
|
| Rate for Payer: Heritage Provider Network Senior |
$55.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
|
|
HC SOM TTFB 84403
|
Facility
OP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$216.05 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.05
|
| Rate for Payer: Blue Shield of California Commercial |
$201.69
|
| Rate for Payer: Blue Shield of California EPN |
$157.67
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.90
|
| Rate for Payer: Heritage Provider Network Senior |
$50.90
|
| Rate for Payer: Humana Medicare |
$25.81
|
| Rate for Payer: IEHP Medi-Cal |
$35.57
|
| Rate for Payer: IEHP Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM UBEMS 81406
|
Facility
IP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$725.62 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$664.67
|
| Rate for Payer: Cash Price |
$435.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.00
|
| Rate for Payer: Heritage Provider Network Senior |
$655.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.88
|
| Rate for Payer: Multiplan Commercial |
$725.62
|
|
|
HC SOM UBEMS 81406
|
Facility
OP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$2,012.18 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$664.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,012.18
|
| Rate for Payer: Blue Shield of California Commercial |
$600.82
|
| Rate for Payer: Blue Shield of California EPN |
$567.92
|
| Rate for Payer: Cash Price |
$435.38
|
| Rate for Payer: Cash Price |
$435.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$628.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$282.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$598.88
|
| Rate for Payer: Heritage Provider Network Senior |
$598.88
|
| Rate for Payer: Humana Medicare |
$282.88
|
| Rate for Payer: IEHP Medi-Cal |
$441.29
|
| Rate for Payer: IEHP Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.43
|
| Rate for Payer: Multiplan Commercial |
$725.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.88
|
| Rate for Payer: TriValley Medical Group Senior |
$282.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
IP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.69
|
| Rate for Payer: Heritage Provider Network Senior |
$241.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
OP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.45
|
| Rate for Payer: Blue Shield of California Commercial |
$143.44
|
| Rate for Payer: Blue Shield of California EPN |
$112.13
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$232.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.98
|
| Rate for Payer: Heritage Provider Network Senior |
$220.98
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: IEHP Medi-Cal |
$25.47
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
IP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$206.61 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.25
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.50
|
| Rate for Payer: Heritage Provider Network Senior |
$186.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.87
|
| Rate for Payer: Multiplan Commercial |
$206.61
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
OP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$622.57 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$150.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.57
|
| Rate for Payer: Blue Shield of California Commercial |
$171.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.71
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$179.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.36
|
| Rate for Payer: Dignity Health Senior |
$150.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.06
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$170.52
|
| Rate for Payer: Heritage Provider Network Senior |
$170.52
|
| Rate for Payer: Humana Medicare |
$150.33
|
| Rate for Payer: IEHP Medi-Cal |
$234.51
|
| Rate for Payer: IEHP Medicare Advantage |
$150.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.42
|
| Rate for Payer: Multiplan Commercial |
$206.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.33
|
| Rate for Payer: TriValley Medical Group Senior |
$150.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Vantage Medical Group Senior |
$150.33
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
OP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$24.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.21
|
| Rate for Payer: Heritage Provider Network Senior |
$23.21
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| 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 |
$28.12
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
IP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.76
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Heritage Provider Network Senior |
$25.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$28.12
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
OP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.77
|
| Rate for Payer: Heritage Provider Network Senior |
$8.77
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.75
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
IP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.73
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.59
|
| Rate for Payer: Heritage Provider Network Senior |
$9.59
|
| 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 |
$10.63
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
OP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$195.82 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.82
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$13.42
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
IP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.02
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.85
|
| Rate for Payer: Heritage Provider Network Senior |
$11.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$102.79 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.99
|
| Rate for Payer: Blue Shield of California Commercial |
$98.83
|
| Rate for Payer: Blue Shield of California EPN |
$77.26
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.86
|
| Rate for Payer: Dignity Health Senior |
$35.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$35.33
|
| Rate for Payer: IEHP Medicare Advantage |
$35.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$67.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.52
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.33
|
| Rate for Payer: TriValley Medical Group Senior |
$35.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Vantage Medical Group Senior |
$35.33
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM VDER 87529
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$38.31
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| 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 |
$37.70
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VDER 87529
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM VDER 87798
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.03
|
| Rate for Payer: Heritage Provider Network Senior |
$34.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
|
|
HC SOM VDER 87798
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.12
|
| Rate for Payer: Heritage Provider Network Senior |
$31.12
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$47.03
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.57
|
| 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 |
$37.70
|
| 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 |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VEDOLIZUMAB AB
|
Facility
OP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$118.28 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.28
|
| Rate for Payer: Blue Shield of California Commercial |
$110.35
|
| Rate for Payer: Blue Shield of California EPN |
$86.26
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.98
|
| Rate for Payer: Heritage Provider Network Senior |
$38.98
|
| Rate for Payer: Humana Medicare |
$14.12
|
| Rate for Payer: IEHP Medi-Cal |
$19.58
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.12
|
| Rate for Payer: TriValley Medical Group Senior |
$14.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM VEDOLIZUMAB AB
|
Facility
IP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$47.24 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.27
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.64
|
| Rate for Payer: Heritage Provider Network Senior |
$42.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.74
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
|
|
HC SOM VEDOLIZUMAB QN
|
Facility
IP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$129.02 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.18
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.46
|
| Rate for Payer: Heritage Provider Network Senior |
$116.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$129.02
|
|
|
HC SOM VEDOLIZUMAB QN
|
Facility
OP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$215.61
|
| Rate for Payer: Blue Shield of California EPN |
$168.55
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.81
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.48
|
| Rate for Payer: Heritage Provider Network Senior |
$106.48
|
| Rate for Payer: Humana Medicare |
$38.57
|
| Rate for Payer: IEHP Medi-Cal |
$48.14
|
| Rate for Payer: IEHP Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$129.02
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
