|
HC STENT SUPERA
|
Facility
IP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,914.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,739.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,153.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,699.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,699.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,453.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,332.22
|
|
|
HC STENT SUPERA
|
Facility
OP
|
$3,987.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.50 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$797.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,914.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,739.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,389.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,193.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,990.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,476.24
|
| Rate for Payer: Blue Shield of California EPN |
$2,340.66
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cash Price |
$1,794.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,834.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,389.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,389.38
|
| Rate for Payer: Dignity Health Senior |
$3,389.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,552.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.88
|
| Rate for Payer: Multiplan Commercial |
$2,990.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,453.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,332.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,389.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,389.38
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,068.18 |
| Max. Negotiated Rate |
$21,000.75 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,956.68
|
| Rate for Payer: Heritage Provider Network Senior |
$18,956.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
906820154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$927.53 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,200.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,332.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$927.53
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
IP
|
$26,298.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,759.94 |
| Max. Negotiated Rate |
$19,723.50 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,803.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,803.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
|
|
HC STENT TIBIOPERONEAL
|
Facility
OP
|
$26,298.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
909020071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$927.53 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,093.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,278.46
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: IEHP Medi-Cal |
$927.53
|
| Rate for Payer: IEHP Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$15,860.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.66 |
| Max. Negotiated Rate |
$13,481.00 |
| Rate for Payer: Adventist Health Commercial |
$3,172.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,895.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,481.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,723.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,895.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,137.00
|
| Rate for Payer: Cash Price |
$7,137.00
|
| Rate for Payer: Cash Price |
$7,137.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,309.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,481.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,481.00
|
| Rate for Payer: Dignity Health Senior |
$13,481.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,817.34
|
| Rate for Payer: Heritage Provider Network Senior |
$9,817.34
|
| Rate for Payer: IEHP Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,644.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,870.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,965.00
|
| Rate for Payer: Multiplan Commercial |
$11,895.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,481.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,481.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$15,860.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
909020075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,870.66 |
| Max. Negotiated Rate |
$11,895.00 |
| Rate for Payer: Adventist Health Commercial |
$3,172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,895.82
|
| Rate for Payer: Cash Price |
$7,137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,737.22
|
| Rate for Payer: Heritage Provider Network Senior |
$10,737.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,870.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,965.00
|
| Rate for Payer: Multiplan Commercial |
$11,895.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
OP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.66 |
| Max. Negotiated Rate |
$13,702.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,702.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,866.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12,090.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,478.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,702.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,702.00
|
| Rate for Payer: Dignity Health Senior |
$13,702.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,978.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9,978.28
|
| Rate for Payer: IEHP Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,769.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,702.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,702.00
|
|
|
HC STENT TIBIOPERONEAL EA ADDL
|
Facility
IP
|
$16,120.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
906820158
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,917.72 |
| Max. Negotiated Rate |
$12,090.00 |
| Rate for Payer: Adventist Health Commercial |
$3,224.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,074.44
|
| Rate for Payer: Cash Price |
$7,254.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,913.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10,913.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,917.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,030.00
|
| Rate for Payer: Multiplan Commercial |
$12,090.00
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,020.01
|
|
|
HC STENT ULTRAFLEX T-B COV W/DEL
|
Facility
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
900803704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,792.11
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Senior |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,020.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
OP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,595.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,679.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,289.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.91
|
| Rate for Payer: Blue Shield of California EPN |
$1,792.11
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,595.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,595.05
|
| Rate for Payer: Dignity Health Senior |
$2,595.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,413.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,413.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,020.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,595.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,595.05
|
|
|
HC STENT ULTRAFLEX T-B NON-COV W/
|
Facility
IP
|
$3,053.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
900803705
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$610.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,465.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,097.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cash Price |
$1,373.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,404.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,648.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,066.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,066.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,526.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,526.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.25
|
| Rate for Payer: Multiplan Commercial |
$2,289.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,113.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,020.01
|
|
|
HC STENT VIABAHN
|
Facility
OP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,660.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,238.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,481.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,193.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,718.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,735.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,475.88
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,481.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,481.25
|
| Rate for Payer: Dignity Health Senior |
$6,481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,780.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,547.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,481.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,481.25
|
|
|
HC STENT VIABAHN
|
Facility
IP
|
$7,625.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909020094
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,525.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,660.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,238.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cash Price |
$3,431.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,117.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,162.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5,162.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,812.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,812.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.25
|
| Rate for Payer: Multiplan Commercial |
$5,718.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,780.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,547.51
|
|
|
HC STENT VIATORR/COVERED
|
Facility
OP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,466.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,000.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,176.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,059.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,845.16
|
| Rate for Payer: Blue Shield of California EPN |
$5,525.14
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,000.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,000.62
|
| Rate for Payer: Dignity Health Senior |
$8,000.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,024.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,357.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,357.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,431.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,144.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,000.62
|
| Rate for Payer: Vantage Medical Group Senior |
$8,000.62
|
|
|
HC STENT VIATORR/COVERED
|
Facility
IP
|
$9,412.50
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,882.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,882.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,518.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,466.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Cash Price |
$4,235.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,329.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,082.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,372.26
|
| Rate for Payer: Heritage Provider Network Senior |
$6,372.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,706.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,706.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,353.12
|
| Rate for Payer: Multiplan Commercial |
$7,059.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,431.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,144.72
|
|
|
HC STENT WINGSPAN
|
Facility
OP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$12,994.38 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,338.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,502.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,994.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,408.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,465.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,493.54
|
| Rate for Payer: Blue Shield of California EPN |
$8,973.76
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,994.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,994.38
|
| Rate for Payer: Dignity Health Senior |
$12,994.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,784.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,078.11
|
| Rate for Payer: Heritage Provider Network Senior |
$7,078.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,573.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,107.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,994.38
|
| Rate for Payer: Vantage Medical Group Senior |
$12,994.38
|
|
|
HC STENT WINGSPAN
|
Facility
IP
|
$15,287.50
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909020055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,057.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$3,057.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,338.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,502.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cash Price |
$6,879.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,032.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,255.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,349.64
|
| Rate for Payer: Heritage Provider Network Senior |
$10,349.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,643.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,643.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,821.88
|
| Rate for Payer: Multiplan Commercial |
$11,465.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,573.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,107.55
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
IP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$580.50 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.74
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$524.00
|
| Rate for Payer: Heritage Provider Network Senior |
$524.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
|
|
HC STEREOTACTIC PROBE 11 GA
|
Facility
OP
|
$774.00
|
|
| Hospital Charge Code |
909001127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.09 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Adventist Health Commercial |
$154.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$413.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$531.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$580.50
|
| Rate for Payer: Blue Shield of California Commercial |
$480.65
|
| Rate for Payer: Blue Shield of California EPN |
$454.34
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$503.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: Dignity Health Senior |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.11
|
| Rate for Payer: Heritage Provider Network Senior |
$479.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$373.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
OP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$492.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Blue Shield of California Commercial |
$571.94
|
| Rate for Payer: Blue Shield of California EPN |
$540.63
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$598.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Senior |
$782.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$570.10
|
| Rate for Payer: Heritage Provider Network Senior |
$570.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$443.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC STEREOTACTIC PROBE 8 GA
|
Facility
IP
|
$921.00
|
|
| Hospital Charge Code |
909001128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.70 |
| Max. Negotiated Rate |
$690.75 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$632.73
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$623.52
|
| Rate for Payer: Heritage Provider Network Senior |
$623.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
|
|
HC STERNO CLAV JOINTS
|
Facility
OP
|
$541.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
909001428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$405.75 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$59.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$371.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.31
|
| Rate for Payer: Blue Shield of California Commercial |
$144.83
|
| Rate for Payer: Blue Shield of California EPN |
$82.36
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cash Price |
$243.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$351.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$351.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.88
|
| Rate for Payer: Heritage Provider Network Senior |
$334.88
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$405.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
