|
HC FO PLASTIC HEEL STABILIZER
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT L3170
|
| Hospital Charge Code |
905353170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$157.50
|
| Rate for Payer: Cigna of CA PPO |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.44
|
| Rate for Payer: United Healthcare All Other HMO |
$82.19
|
| Rate for Payer: United Healthcare HMO Rider |
$80.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.69
|
|
|
HC FOREARM
|
Facility
|
IP
|
$617.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$431.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.80
|
| Rate for Payer: EPIC Health Plan Senior |
$246.80
|
| Rate for Payer: Galaxy Health WC |
$524.45
|
| Rate for Payer: Global Benefits Group Commercial |
$370.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.08
|
| Rate for Payer: Multiplan Commercial |
$493.60
|
| Rate for Payer: Networks By Design Commercial |
$401.05
|
| Rate for Payer: Prime Health Services Commercial |
$524.45
|
|
|
HC FOREARM
|
Facility
|
OP
|
$617.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$524.45 |
| Rate for Payer: Adventist Health Commercial |
$123.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.13
|
| Rate for Payer: Blue Shield of California Commercial |
$259.76
|
| Rate for Payer: Blue Shield of California Commercial |
$393.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cash Price |
$277.65
|
| Rate for Payer: Cigna of CA HMO |
$394.88
|
| Rate for Payer: Cigna of CA PPO |
$456.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$431.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$524.45
|
| Rate for Payer: Global Benefits Group Commercial |
$370.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$391.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$493.60
|
| Rate for Payer: Networks By Design Commercial |
$401.05
|
| Rate for Payer: Prime Health Services Commercial |
$524.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.09
|
| Rate for Payer: Blue Shield of California Commercial |
$113.67
|
| Rate for Payer: Blue Shield of California Commercial |
$172.26
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$1,271.60 |
| Rate for Payer: Adventist Health Commercial |
$299.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$598.40
|
| Rate for Payer: Galaxy Health WC |
$1,271.60
|
| Rate for Payer: Global Benefits Group Commercial |
$897.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$949.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$882.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.04
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: Networks By Design Commercial |
$972.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,271.60
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$299.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cigna of CA HMO |
$957.44
|
| Rate for Payer: Cigna of CA PPO |
$1,107.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,271.60
|
| Rate for Payer: Global Benefits Group Commercial |
$897.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$949.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$972.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,271.60
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$897.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$748.00
|
| Rate for Payer: United Healthcare HMO Rider |
$748.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$748.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.70
|
| Rate for Payer: Blue Shield of California Commercial |
$246.08
|
| Rate for Payer: Blue Shield of California Commercial |
$162.24
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$203.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$231.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$160.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.05
|
| Rate for Payer: Blue Shield of California Commercial |
$42.41
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.88
|
| Rate for Payer: EPIC Health Plan Senior |
$9.92
|
| Rate for Payer: EPIC Health Plan Senior |
$9.92
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$361.55 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.34
|
| Rate for Payer: Blue Shield of California Commercial |
$275.22
|
| Rate for Payer: Blue Shield of California Commercial |
$118.49
|
| Rate for Payer: Blue Shield of California Commercial |
$416.11
|
| Rate for Payer: Blue Shield of California Commercial |
$78.37
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$382.08
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Cigna of CA PPO |
$441.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$417.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$417.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC FSH
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FSH
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$191.79 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.79
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$59.47
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Blue Shield of California Commercial |
$89.91
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.66
|
| Rate for Payer: EPIC Health Plan Senior |
$20.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20.44
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,793.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6,090.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,015.44
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,029.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,672.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,029.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,672.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,148.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,793.98
|
| Rate for Payer: Blue Shield of California Commercial |
$6,090.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4,015.44
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,029.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,672.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,029.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,672.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,148.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.58
|
| Rate for Payer: Blue Shield of California Commercial |
$84.59
|
| Rate for Payer: Blue Shield of California Commercial |
$55.77
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.58
|
| Rate for Payer: Blue Shield of California Commercial |
$84.59
|
| Rate for Payer: Blue Shield of California Commercial |
$55.77
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna of CA HMO |
$2,598.40
|
| Rate for Payer: Cigna of CA PPO |
$3,004.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,578.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,030.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,030.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,030.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,030.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$3,451.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.00
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,578.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,395.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
|
