|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.12
|
| Rate for Payer: Heritage Provider Network Senior |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
IP
|
$789.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.81 |
| Max. Negotiated Rate |
$591.75 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.04
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$534.15
|
| Rate for Payer: Heritage Provider Network Senior |
$534.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.25
|
| Rate for Payer: Multiplan Commercial |
$591.75
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
OP
|
$789.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.84 |
| Max. Negotiated Rate |
$591.75 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$103.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$542.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$448.89
|
| Rate for Payer: Blue Shield of California Commercial |
$252.43
|
| Rate for Payer: Blue Shield of California EPN |
$143.55
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$512.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$488.39
|
| Rate for Payer: Heritage Provider Network Senior |
$488.39
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$87.84
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$591.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
IP
|
$1,284.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.11
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$869.27
|
| Rate for Payer: Heritage Provider Network Senior |
$869.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.00
|
| Rate for Payer: Multiplan Commercial |
$963.00
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
OP
|
$1,284.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$963.00 |
| Rate for Payer: Adventist Health Commercial |
$256.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$111.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$882.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.32
|
| Rate for Payer: Blue Shield of California Commercial |
$273.96
|
| Rate for Payer: Blue Shield of California EPN |
$155.79
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cash Price |
$577.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$834.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$834.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.80
|
| Rate for Payer: Heritage Provider Network Senior |
$794.80
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$95.35
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$963.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
IP
|
$1,644.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.56 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,129.43
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,112.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,112.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.00
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.05 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Adventist Health Commercial |
$328.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,129.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.92
|
| Rate for Payer: Blue Shield of California Commercial |
$328.90
|
| Rate for Payer: Blue Shield of California EPN |
$187.04
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cash Price |
$739.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,068.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,017.64
|
| Rate for Payer: Heritage Provider Network Senior |
$1,017.64
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$114.05
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,233.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$290.25 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$265.87
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.00
|
| Rate for Payer: Heritage Provider Network Senior |
$262.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$290.25
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$290.25 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$42.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$265.87
|
| 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 |
$186.47
|
| Rate for Payer: Blue Shield of California Commercial |
$105.32
|
| Rate for Payer: Blue Shield of California EPN |
$59.89
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$251.55
|
| 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 |
$251.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$239.55
|
| Rate for Payer: Heritage Provider Network Senior |
$239.55
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$38.91
|
| 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 |
$70.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.75
|
| 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 |
$290.25
|
| 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 |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| 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
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
IP
|
$759.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.38 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.84
|
| Rate for Payer: Heritage Provider Network Senior |
$513.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$569.25
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
OP
|
$759.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$569.25 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.43
|
| 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 |
$221.63
|
| Rate for Payer: Blue Shield of California Commercial |
$124.93
|
| Rate for Payer: Blue Shield of California EPN |
$71.05
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$493.35
|
| 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 |
$493.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.82
|
| Rate for Payer: Heritage Provider Network Senior |
$469.82
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$45.47
|
| 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 |
$137.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.75
|
| 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 |
$569.25
|
| 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 |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| 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
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
OP
|
$857.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.29 |
| Max. Negotiated Rate |
$642.75 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$588.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.64
|
| Rate for Payer: Blue Shield of California Commercial |
$154.34
|
| Rate for Payer: Blue Shield of California EPN |
$87.77
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$557.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.48
|
| Rate for Payer: Heritage Provider Network Senior |
$530.48
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$54.29
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
IP
|
$857.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.12 |
| Max. Negotiated Rate |
$642.75 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$588.76
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$580.19
|
| Rate for Payer: Heritage Provider Network Senior |
$580.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.25
|
| Rate for Payer: Multiplan Commercial |
$642.75
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.41 |
| Max. Negotiated Rate |
$977.25 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.50
|
| Rate for Payer: Blue Shield of California Commercial |
$183.79
|
| Rate for Payer: Blue Shield of California EPN |
$104.52
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$846.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$806.56
|
| Rate for Payer: Heritage Provider Network Senior |
$806.56
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$68.41
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.84 |
| Max. Negotiated Rate |
$977.25 |
| Rate for Payer: Adventist Health Commercial |
$260.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$895.16
|
| Rate for Payer: Cash Price |
$586.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.13
|
| Rate for Payer: Heritage Provider Network Senior |
$882.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.75
|
| Rate for Payer: Multiplan Commercial |
$977.25
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$939.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.88
|
| Rate for Payer: Blue Shield of California Commercial |
$221.02
|
| Rate for Payer: Blue Shield of California EPN |
$125.69
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$889.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.79
|
| Rate for Payer: Heritage Provider Network Senior |
$846.79
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$79.62
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.61 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$939.82
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$926.14
|
| Rate for Payer: Heritage Provider Network Senior |
$926.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$1,026.00
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
OP
|
$555.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.28
|
| 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 |
$196.83
|
| Rate for Payer: Blue Shield of California Commercial |
$111.23
|
| Rate for Payer: Blue Shield of California EPN |
$63.26
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$360.75
|
| 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 |
$360.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$343.54
|
| Rate for Payer: Heritage Provider Network Senior |
$343.54
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$41.36
|
| 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 |
$100.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| 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 |
$416.25
|
| 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 |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| 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
|
|
|
HC XRAY HIP W/PELVIS UNI 1 VIEW
|
Facility
IP
|
$555.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
909073501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.46 |
| Max. Negotiated Rate |
$416.25 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.28
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$375.74
|
| Rate for Payer: Heritage Provider Network Senior |
$375.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
OP
|
$776.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| 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 |
$291.28
|
| Rate for Payer: Blue Shield of California Commercial |
$164.17
|
| Rate for Payer: Blue Shield of California EPN |
$93.36
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$504.40
|
| 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 |
$504.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.34
|
| Rate for Payer: Heritage Provider Network Senior |
$480.34
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$58.16
|
| 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 |
$140.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| 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 |
$582.00
|
| 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 |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| 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
|
|
|
HC XRAY HIP W/PELVIS UNI 2-3 VIEW
|
Facility
IP
|
$776.00
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
909073502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
OP
|
$1,230.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.87
|
| Rate for Payer: Blue Shield of California Commercial |
$203.41
|
| Rate for Payer: Blue Shield of California EPN |
$115.67
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$799.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$761.37
|
| Rate for Payer: Heritage Provider Network Senior |
$761.37
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$72.65
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC XRAY HIP W/PELVIS UNI 4 GT VIEWS
|
Facility
IP
|
$1,230.00
|
|
|
Service Code
|
CPT 73503
|
| Hospital Charge Code |
909073503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.63 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Adventist Health Commercial |
$246.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$845.01
|
| Rate for Payer: Cash Price |
$553.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.71
|
| Rate for Payer: Heritage Provider Network Senior |
$832.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$922.50
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$399.43
|
| Rate for Payer: Heritage Provider Network Senior |
$399.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
|
|
HC XRAY SKULL RADIOGRAPH LTD
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
908801144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.53 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Adventist Health Commercial |
$118.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.65
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.88
|
| Rate for Payer: Blue Shield of California Commercial |
$127.22
|
| Rate for Payer: Blue Shield of California EPN |
$72.34
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$383.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$365.21
|
| Rate for Payer: Heritage Provider Network Senior |
$365.21
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$40.53
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$442.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
