|
HC TIP DEFLECTING WIRE
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081233
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Blue Shield of California Commercial |
$120.78
|
| Rate for Payer: Blue Shield of California EPN |
$96.62
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$128.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Senior |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.56
|
| Rate for Payer: Heritage Provider Network Senior |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$94.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$99.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$99.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC TIPS CATHETER SET
|
Facility
|
OP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$567.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$729.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$584.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$796.50
|
| Rate for Payer: Blue Shield of California Commercial |
$647.82
|
| Rate for Payer: Blue Shield of California EPN |
$518.26
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$690.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$902.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$902.70
|
| Rate for Payer: Dignity Health Senior |
$902.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.38
|
| Rate for Payer: Heritage Provider Network Senior |
$657.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$743.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$531.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$531.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$902.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$902.70
|
| Rate for Payer: Vantage Medical Group Senior |
$902.70
|
|
|
HC TIPS CATHETER SET
|
Facility
|
IP
|
$1,062.00
|
|
| Hospital Charge Code |
909081222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$796.50 |
| Rate for Payer: Adventist Health Commercial |
$212.40
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.97
|
| Rate for Payer: Heritage Provider Network Senior |
$718.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.50
|
| Rate for Payer: Multiplan Commercial |
$796.50
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
OP
|
$12,014.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,861.00 |
| Rate for Payer: Adventist Health Commercial |
$2,402.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,253.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,211.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,607.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,010.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,809.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,211.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,211.90
|
| Rate for Payer: Dignity Health Senior |
$10,211.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,436.67
|
| Rate for Payer: Heritage Provider Network Senior |
$7,436.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,730.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,174.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,003.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,409.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,409.80
|
| Rate for Payer: Multiplan Commercial |
$9,010.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,211.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,211.90
|
| Rate for Payer: Vantage Medical Group Senior |
$10,211.90
|
|
|
HC T.I.P.S. (PORTOCAVAL SHUNT)
|
Facility
|
IP
|
$12,014.00
|
|
|
Service Code
|
CPT 37182
|
| Hospital Charge Code |
909081331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,174.53 |
| Max. Negotiated Rate |
$9,010.50 |
| Rate for Payer: Adventist Health Commercial |
$2,402.80
|
| Rate for Payer: Cash Price |
$5,406.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,133.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8,133.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,174.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,003.50
|
| Rate for Payer: Multiplan Commercial |
$9,010.50
|
|
|
HC TIPS TX SHEATH
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.01
|
| Rate for Payer: Heritage Provider Network Senior |
$197.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
|
|
HC TIPS TX SHEATH
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Blue Shield of California Commercial |
$177.51
|
| Rate for Payer: Blue Shield of California EPN |
$142.01
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Senior |
$247.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.70
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$145.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$145.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$117.29 |
| Max. Negotiated Rate |
$1,016.47 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$346.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$445.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.47
|
| Rate for Payer: Blue Shield of California EPN |
$815.29
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$421.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Senior |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$143.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.11
|
| Rate for Payer: Heritage Provider Network Senior |
$401.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$161.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$309.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.75
|
| Rate for Payer: TriValley Medical Group Senior |
$143.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$155.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$135.03 |
| Max. Negotiated Rate |
$559.50 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$505.04
|
| Rate for Payer: Heritage Provider Network Senior |
$505.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.50
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$1,303.26 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$202.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,303.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,187.25
|
| Rate for Payer: Blue Shield of California EPN |
$952.27
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$191.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$147.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.60
|
| Rate for Payer: Heritage Provider Network Senior |
$182.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.88
|
| Rate for Payer: Multiplan Commercial |
$221.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.52
|
| Rate for Payer: TriValley Medical Group Senior |
$147.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$277.57
|
| Rate for Payer: Heritage Provider Network Senior |
$277.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$1,185.06 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.06
|
| Rate for Payer: Blue Shield of California EPN |
$950.52
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$150.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.38
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$150.30
|
| Rate for Payer: TriValley Medical Group Senior |
$150.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$162.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.83
|
| Rate for Payer: Heritage Provider Network Senior |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.59 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$641.80
|
| Rate for Payer: Heritage Provider Network Senior |
$641.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$711.00
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$937.56 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$365.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.95
|
| Rate for Payer: Blue Shield of California Commercial |
$937.56
|
| Rate for Payer: Blue Shield of California EPN |
$752.00
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$444.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$116.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.40
|
| Rate for Payer: Heritage Provider Network Senior |
$423.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.78
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$116.49
|
| Rate for Payer: TriValley Medical Group Senior |
$116.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$125.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$1,132.59 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.59
|
| Rate for Payer: Blue Shield of California EPN |
$908.43
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$140.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.13
|
| Rate for Payer: Heritage Provider Network Senior |
$180.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$202.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.32
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$140.73
|
| Rate for Payer: TriValley Medical Group Senior |
$140.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$151.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$151.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.83
|
| Rate for Payer: Heritage Provider Network Senior |
$272.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.75
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,053.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,507.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.99
|
| Rate for Payer: Blue Shield of California EPN |
$881.99
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Senior |
$1,864.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,535.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$792.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$726.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,053.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.99
|
| Rate for Payer: Blue Shield of California EPN |
$881.99
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,009.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,097.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$548.50
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$792.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$726.43
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$53.72 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.72
|
| Rate for Payer: Blue Shield of California Commercial |
$47.35
|
| Rate for Payer: Blue Shield of California EPN |
$37.98
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.71
|
| Rate for Payer: Heritage Provider Network Senior |
$16.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.41
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.88
|
| Rate for Payer: TriValley Medical Group Senior |
$5.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.30
|
| Rate for Payer: Heritage Provider Network Senior |
$85.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.46
|
| Rate for Payer: Blue Shield of California EPN |
$172.46
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Senior |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$205.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.46
|
| Rate for Payer: Blue Shield of California EPN |
$172.46
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$197.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$231.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$198.63
|
| Rate for Payer: Heritage Provider Network Senior |
$198.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.25
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$155.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$142.04
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
IP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$589.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.33
|
| Rate for Payer: Blue Shield of California EPN |
$493.33
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.19
|
| Rate for Payer: Heritage Provider Network Senior |
$568.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.33
|
|
|
HC TISSUE MARKER 18GA
|
Facility
|
OP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$589.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$843.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$920.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$493.33
|
| Rate for Payer: Blue Shield of California EPN |
$493.33
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cigna of CA HMO/PPO |
$564.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,043.12
|
| Rate for Payer: Dignity Health Senior |
$1,043.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.19
|
| Rate for Payer: Heritage Provider Network Senior |
$568.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$859.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$859.04
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$443.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$406.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,043.12
|
|
