|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$398.25 |
| Rate for Payer: Adventist Health Commercial |
$106.20
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.49
|
| Rate for Payer: Heritage Provider Network Senior |
$359.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$398.25
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
906820170
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$106.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$364.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$451.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$398.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$345.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$451.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$451.35
|
| Rate for Payer: Dignity Health Senior |
$451.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.69
|
| Rate for Payer: Heritage Provider Network Senior |
$328.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.70
|
| Rate for Payer: Multiplan Commercial |
$398.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$451.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$451.35
|
| Rate for Payer: Vantage Medical Group Senior |
$451.35
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$338.25 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.33
|
| Rate for Payer: Heritage Provider Network Senior |
$305.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
|
|
HC VENOUS 2ND/3RD ORDER CATH P
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
909081310
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$338.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$248.05
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Cash Price |
$248.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$383.35
|
| Rate for Payer: Dignity Health Senior |
$383.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.17
|
| Rate for Payer: Heritage Provider Network Senior |
$279.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.70
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Vantage Medical Group Senior |
$383.35
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,218.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$975.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,329.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$712.75
|
| Rate for Payer: Blue Shield of California EPN |
$712.75
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,507.05
|
| Rate for Payer: Dignity Health Senior |
$1,507.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.90
|
| Rate for Payer: Heritage Provider Network Senior |
$820.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,241.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,241.10
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$640.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$587.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,507.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,507.05
|
|
|
HC VENOUS ACCESS PORT
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$354.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$851.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$712.75
|
| Rate for Payer: Blue Shield of California EPN |
$712.75
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$815.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$957.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.90
|
| Rate for Payer: Heritage Provider Network Senior |
$820.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$886.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.25
|
| Rate for Payer: Multiplan Commercial |
$1,329.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$640.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$587.04
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$659.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$720.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$624.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$816.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$816.00
|
| Rate for Payer: Dignity Health Senior |
$816.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$594.24
|
| Rate for Payer: Heritage Provider Network Senior |
$594.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$457.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$672.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$816.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$816.00
|
| Rate for Payer: Vantage Medical Group Senior |
$816.00
|
|
|
HC VENOUS BLOOD SAMPLING
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
909081329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$649.92
|
| Rate for Payer: Heritage Provider Network Senior |
$649.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,211.30 |
| Max. Negotiated Rate |
$13,306.50 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,011.33
|
| Rate for Payer: Heritage Provider Network Senior |
$12,011.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,211.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,435.50
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$17,742.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
909081846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,548.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$9,758.10
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Cash Price |
$9,758.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,532.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,982.30
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,156.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,211.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,435.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$13,306.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
OP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,599.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,028.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,549.93
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,156.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,792.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,857.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$11,571.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC VENOUS MECH THROMBECTOMY
|
Facility
|
IP
|
$15,428.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
906820200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,792.47 |
| Max. Negotiated Rate |
$11,571.00 |
| Rate for Payer: Adventist Health Commercial |
$3,085.60
|
| Rate for Payer: Cash Price |
$8,485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,444.76
|
| Rate for Payer: Heritage Provider Network Senior |
$10,444.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,792.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,857.00
|
| Rate for Payer: Multiplan Commercial |
$11,571.00
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
IP
|
$18,970.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,433.57 |
| Max. Negotiated Rate |
$14,227.50 |
| Rate for Payer: Adventist Health Commercial |
$3,794.00
|
| Rate for Payer: Cash Price |
$10,433.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,842.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12,842.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,433.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,742.50
|
| Rate for Payer: Multiplan Commercial |
$14,227.50
|
|
|
HC VENOUS M-THROMBECTOMY ADD-ON
|
Facility
|
OP
|
$18,970.00
|
|
|
Service Code
|
CPT 37188
|
| Hospital Charge Code |
909081847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,227.50 |
| Rate for Payer: Adventist Health Commercial |
$3,794.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,032.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$10,433.50
|
| Rate for Payer: Cash Price |
$10,433.50
|
| Rate for Payer: Cash Price |
$10,433.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,330.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,742.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$720.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,433.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,742.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$14,227.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC VENOUS SAMPLING
|
Facility
|
OP
|
$9,087.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$10,302.72 |
| Rate for Payer: Adventist Health Commercial |
$1,817.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,242.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,273.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$4,997.85
|
| Rate for Payer: Cash Price |
$4,997.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,906.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,906.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,624.85
|
| Rate for Payer: Heritage Provider Network Senior |
$5,624.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,334.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,644.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$6,815.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,868.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6,868.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VENOUS SAMPLING
|
Facility
|
IP
|
$9,087.00
|
|
|
Service Code
|
CPT 75893
|
| Hospital Charge Code |
909081644
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,644.75 |
| Max. Negotiated Rate |
$6,815.25 |
| Rate for Payer: Adventist Health Commercial |
$1,817.40
|
| Rate for Payer: Cash Price |
$4,997.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,151.90
|
| Rate for Payer: Heritage Provider Network Senior |
$6,151.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,644.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,271.75
|
| Rate for Payer: Multiplan Commercial |
$6,815.25
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$785.32
|
| Rate for Payer: Heritage Provider Network Senior |
$785.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
|
|
HC VENOUS THROMBUS SCAN
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 78458
|
| Hospital Charge Code |
909301387
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Adventist Health Commercial |
$232.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$620.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$796.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$846.38
|
| Rate for Payer: Blue Shield of California EPN |
$680.63
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$754.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$754.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$718.04
|
| Rate for Payer: Heritage Provider Network Senior |
$718.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$152.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$553.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$870.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$580.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$580.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$676.94 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,531.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,531.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
|
|
HC VENT ASSIST& MGT-INITIAL DAILY
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800100
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,999.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,431.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Senior |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,431.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$839.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,783.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,058.39
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$615.40 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,301.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,301.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
|
|
HC VENT ASSIST & MGT SUB DAILY
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,817.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Senior |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$839.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,058.39
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.89 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$361.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cash Price |
$993.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,173.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,222.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,222.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$861.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,354.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$649.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$597.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC VENT TUBE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Blue Shield of California Commercial |
$183.00
|
| Rate for Payer: Blue Shield of California EPN |
$146.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$185.70
|
| Rate for Payer: Heritage Provider Network Senior |
$185.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
