|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$672,453.45
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$537,077.96 |
| Max. Negotiated Rate |
$672,453.45 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$537,077.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672,453.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601,668.88
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$282,128.80
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$225,331.81 |
| Max. Negotiated Rate |
$282,128.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225,331.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282,128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252,431.03
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$417,425.88
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$333,391.46 |
| Max. Negotiated Rate |
$417,425.88 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$333,391.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$417,425.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$373,486.31
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$282,128.80
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$225,331.81 |
| Max. Negotiated Rate |
$282,128.80 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225,331.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$282,128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252,431.03
|
|
|
IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH MAGNETIC TRANSCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR, WITHIN THE MASTOID AND/OR RESULTING IN REMOVAL OF LESS THAN 100 SQ MM SURFACE AREA OF BONE DEEP TO THE OUTER CRANIAL CORTEX
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 69716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.99 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,805.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,127.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR
|
Facility
|
OP
|
$50,447.00
|
|
|
Service Code
|
CPT 69714
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$671.13 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,512.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31,445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,163.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,512.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$27,245.94
|
| Rate for Payer: EPIC Health Plan Senior |
$18,163.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27,080.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$671.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,512.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$759.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,117.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,805.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,127.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,512.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,769.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,163.96
|
| Rate for Payer: Vantage Medical Group Senior |
$16,512.69
|
|
|
IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 21085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$426.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$104,484.53
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$6,823.00 |
| Max. Negotiated Rate |
$104,484.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43,112.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,484.53
|
| Rate for Payer: EPIC Health Plan Senior |
$69,656.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,323.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,653.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,854.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,448.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,823.00
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$81,635.12
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$65,200.68 |
| Max. Negotiated Rate |
$81,635.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65,200.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81,635.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73,041.95
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$24,907.48
|
|
|
Service Code
|
APR-DRG 4233
|
| Min. Negotiated Rate |
$19,893.21 |
| Max. Negotiated Rate |
$24,907.48 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,893.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,907.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,285.64
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$11,874.56
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$9,484.03 |
| Max. Negotiated Rate |
$11,874.56 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9,484.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11,874.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,624.61
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$16,304.07
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$13,021.80 |
| Max. Negotiated Rate |
$16,304.07 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,021.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16,304.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,587.85
|
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 10061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.85 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 46040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$300.22 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$300.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 10080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,147.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,220.45
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
INCISION OF LINGUAL FRENUM (FRENOTOMY)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 41010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.07 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$257.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,793.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE [233001]
|
Facility
|
IP
|
$2,984.99
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$2,537.24 |
| Rate for Payer: Adventist Health Commercial |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,513.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,295.46
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cigna of CA HMO |
$2,089.49
|
| Rate for Payer: Cigna of CA PPO |
$2,089.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,089.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,194.00
|
| Rate for Payer: Galaxy Health WC |
$2,537.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,895.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,761.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.40
|
| Rate for Payer: Multiplan Commercial |
$2,387.99
|
| Rate for Payer: Networks By Design Commercial |
$1,492.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,537.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,120.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,090.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$977.58
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE [233001]
|
Facility
|
OP
|
$2,984.99
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$2,537.24 |
| Rate for Payer: Adventist Health Commercial |
$597.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.31
|
| Rate for Payer: Blue Shield of California Commercial |
$14.43
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cash Price |
$1,343.25
|
| Rate for Payer: Cigna of CA HMO |
$2,089.49
|
| Rate for Payer: Cigna of CA PPO |
$2,089.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,089.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$2,537.24
|
| Rate for Payer: Global Benefits Group Commercial |
$1,790.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,895.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$716.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.30
|
| Rate for Payer: Multiplan Commercial |
$2,387.99
|
| Rate for Payer: Networks By Design Commercial |
$1,492.49
|
| Rate for Payer: Prime Health Services Commercial |
$2,537.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,790.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,790.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,120.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1,090.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,066.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$977.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.20
|
| Rate for Payer: Vantage Medical Group Senior |
$14.20
|
|
|
INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION [105971]
|
Facility
|
OP
|
$613.20
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$521.22 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.23
|
| Rate for Payer: Cash Price |
$275.94
|
| Rate for Payer: Cash Price |
$275.94
|
| Rate for Payer: Cigna of CA HMO |
$429.24
|
| Rate for Payer: Cigna of CA PPO |
$429.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$521.22
|
| Rate for Payer: Global Benefits Group Commercial |
$367.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.09
|
| Rate for Payer: Multiplan Commercial |
$490.56
|
| Rate for Payer: Networks By Design Commercial |
$306.60
|
| Rate for Payer: Prime Health Services Commercial |
$521.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.13
|
| Rate for Payer: United Healthcare All Other HMO |
$224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$219.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.82
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION [105971]
|
Facility
|
IP
|
$613.20
|
|
|
Service Code
|
HCPCS J0588
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.64 |
| Max. Negotiated Rate |
$521.22 |
| Rate for Payer: Adventist Health Commercial |
$122.64
|
| Rate for Payer: Blue Shield of California Commercial |
$310.89
|
| Rate for Payer: Blue Shield of California Commercial |
$471.55
|
| Rate for Payer: Cash Price |
$275.94
|
| Rate for Payer: Cigna of CA HMO |
$429.24
|
| Rate for Payer: Cigna of CA PPO |
$429.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$429.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.28
|
| Rate for Payer: EPIC Health Plan Senior |
$245.28
|
| Rate for Payer: Galaxy Health WC |
$521.22
|
| Rate for Payer: Global Benefits Group Commercial |
$367.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$389.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.17
|
| Rate for Payer: Multiplan Commercial |
$490.56
|
| Rate for Payer: Networks By Design Commercial |
$306.60
|
| Rate for Payer: Prime Health Services Commercial |
$521.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.13
|
| Rate for Payer: United Healthcare All Other HMO |
$224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$219.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.82
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [235583]
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$48.67
|
| Rate for Payer: Blue Shield of California Commercial |
$73.82
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.03
|
| Rate for Payer: United Healthcare All Other HMO |
$35.07
|
| Rate for Payer: United Healthcare HMO Rider |
$34.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.44
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INTRAVENOUS SOLUTION [235583]
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$67.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$48.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.03
|
| Rate for Payer: United Healthcare All Other HMO |
$35.07
|
| Rate for Payer: United Healthcare HMO Rider |
$34.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT [13545]
|
Facility
|
IP
|
$4,608.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$921.60 |
| Max. Negotiated Rate |
$3,916.80 |
| Rate for Payer: Adventist Health Commercial |
$921.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,336.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,543.55
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,843.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,843.20
|
| Rate for Payer: Galaxy Health WC |
$3,916.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,764.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,926.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,718.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.92
|
| Rate for Payer: Multiplan Commercial |
$3,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,995.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,916.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,729.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,683.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1,646.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,509.12
|
|
|
INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT [13545]
|
Facility
|
OP
|
$4,608.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
901700057
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$921.60 |
| Max. Negotiated Rate |
$23,012.94 |
| Rate for Payer: Adventist Health Commercial |
$921.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,201.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23,012.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,939.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,939.90
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cigna of CA HMO |
$2,949.12
|
| Rate for Payer: Cigna of CA PPO |
$3,409.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,201.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,301.55
|
| Rate for Payer: EPIC Health Plan Senior |
$2,201.03
|
| Rate for Payer: Galaxy Health WC |
$3,916.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,764.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,000.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,926.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,801.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.26
|
| Rate for Payer: Multiplan Commercial |
$3,686.40
|
| Rate for Payer: Networks By Design Commercial |
$2,995.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,916.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,764.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,764.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,729.38
|
| Rate for Payer: United Healthcare All Other HMO |
$1,683.30
|
| Rate for Payer: United Healthcare HMO Rider |
$1,646.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,509.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,000.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,501.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.03
|
| Rate for Payer: Vantage Medical Group Senior |
$2,201.03
|
|
|
INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION [10266]
|
Facility
|
IP
|
$244.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.90 |
| Max. Negotiated Rate |
$207.82 |
| Rate for Payer: Adventist Health Commercial |
$48.90
|
| Rate for Payer: Blue Shield of California Commercial |
$123.96
|
| Rate for Payer: Blue Shield of California Commercial |
$188.02
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cigna of CA HMO |
$171.15
|
| Rate for Payer: Cigna of CA PPO |
$171.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.80
|
| Rate for Payer: EPIC Health Plan Senior |
$97.80
|
| Rate for Payer: Galaxy Health WC |
$207.82
|
| Rate for Payer: Global Benefits Group Commercial |
$146.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.68
|
| Rate for Payer: Multiplan Commercial |
$195.60
|
| Rate for Payer: Networks By Design Commercial |
$122.25
|
| Rate for Payer: Prime Health Services Commercial |
$207.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.76
|
| Rate for Payer: United Healthcare All Other HMO |
$89.32
|
| Rate for Payer: United Healthcare HMO Rider |
$87.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.07
|
|
