|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,300.50 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$926.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,176.57
|
| Rate for Payer: Blue Shield of California Commercial |
$775.71
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.20
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.40
|
| Rate for Payer: Multiplan Commercial |
$3,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,695.38 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,631.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,204.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,343.23
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,695.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,578.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,043.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,043.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,043.25
|
| Rate for Payer: Multiplan Commercial |
$3,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,007.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$985.65
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$557.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$63.43
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$82.94 |
| Rate for Payer: Adventist Health Commercial |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$49.47
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.94
|
| Rate for Payer: Vantage Medical Group Senior |
$82.94
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$19.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$63.43
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$82.94 |
| Rate for Payer: Adventist Health Commercial |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.07
|
| Rate for Payer: Blue Shield of California Commercial |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$49.47
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cash Price |
$43.91
|
| Rate for Payer: Cigna of CA HMO |
$68.31
|
| Rate for Payer: Cigna of CA PPO |
$68.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Senior |
$39.03
|
| Rate for Payer: Galaxy Health WC |
$82.94
|
| Rate for Payer: Global Benefits Group Commercial |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Networks By Design Commercial |
$48.79
|
| Rate for Payer: Prime Health Services Commercial |
$82.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.62
|
| Rate for Payer: United Healthcare All Other HMO |
$35.65
|
| Rate for Payer: United Healthcare HMO Rider |
$34.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.94
|
| Rate for Payer: Vantage Medical Group Senior |
$82.94
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$91.20
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.52
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cigna of CA HMO |
$58.37
|
| Rate for Payer: Cigna of CA PPO |
$67.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.60
|
| Rate for Payer: United Healthcare All Other HMO |
$45.60
|
| Rate for Payer: United Healthcare HMO Rider |
$45.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.52
|
| Rate for Payer: Vantage Medical Group Senior |
$77.52
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$91.20
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$18.24
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.48
|
| Rate for Payer: EPIC Health Plan Senior |
$36.48
|
| Rate for Payer: Galaxy Health WC |
$77.52
|
| Rate for Payer: Global Benefits Group Commercial |
$54.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.89
|
| Rate for Payer: Multiplan Commercial |
$72.96
|
| Rate for Payer: Networks By Design Commercial |
$59.28
|
| Rate for Payer: Prime Health Services Commercial |
$77.52
|
|
|
HC GENETIC CNSLG PT/FMLY 30MIN EA
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 96041
|
| Hospital Charge Code |
910406040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC GENETIC CNSLG PT/FMLY 30MIN EA
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 96041
|
| Hospital Charge Code |
910406040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$358.11 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$358.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.69
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$186.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.20
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.00
|
| Rate for Payer: United Healthcare All Other HMO |
$133.00
|
| Rate for Payer: United Healthcare HMO Rider |
$133.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.22
|
| Rate for Payer: Blue Shield of California Commercial |
$22.59
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$3,957.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$3,363.45 |
| Rate for Payer: Adventist Health Commercial |
$791.40
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,769.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,582.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,582.80
|
| Rate for Payer: Galaxy Health WC |
$3,363.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,512.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,334.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.68
|
| Rate for Payer: Multiplan Commercial |
$3,165.60
|
| Rate for Payer: Networks By Design Commercial |
$2,572.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,363.45
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$3,957.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$218.06 |
| Max. Negotiated Rate |
$3,363.45 |
| Rate for Payer: Adventist Health Commercial |
$791.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,722.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,539.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,524.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.90
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: Cash Price |
$1,780.65
|
| Rate for Payer: Cigna of CA HMO |
$2,532.48
|
| Rate for Payer: Cigna of CA PPO |
$2,928.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,769.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$3,363.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,374.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,512.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$3,165.60
|
| Rate for Payer: Networks By Design Commercial |
$2,572.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,363.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,374.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,374.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,118.60 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$921.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$835.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$776.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.84
|
| Rate for Payer: Multiplan Commercial |
$1,052.80
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC GI ENDOSCOPIC ULTRASOUND
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$1,118.60 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,101.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$844.48
|
| Rate for Payer: Blue Shield of California Commercial |
$839.61
|
| Rate for Payer: Blue Shield of California Commercial |
$554.04
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$921.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$835.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$315.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,052.80
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.46
|
| Rate for Payer: United Healthcare All Other HMO |
$389.46
|
| Rate for Payer: United Healthcare HMO Rider |
$389.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
IP
|
$3,283.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$656.60 |
| Max. Negotiated Rate |
$2,790.55 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,298.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,313.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,313.20
|
| Rate for Payer: Galaxy Health WC |
$2,790.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,969.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,084.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,936.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.92
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: Networks By Design Commercial |
$2,133.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,790.55
|
|
|
HC GI INJ TREATMENT NR
|
Facility
|
OP
|
$3,283.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
906764640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$656.60
|
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$1,477.35
|
| Rate for Payer: Cigna of CA HMO |
$2,101.12
|
| Rate for Payer: Cigna of CA HMO |
$1,255.04
|
| Rate for Payer: Cigna of CA PPO |
$1,451.14
|
| Rate for Payer: Cigna of CA PPO |
$2,429.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,298.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,790.55
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,969.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,084.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$238.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$238.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Multiplan Commercial |
$2,626.40
|
| Rate for Payer: Networks By Design Commercial |
$2,133.95
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,790.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,969.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$980.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,641.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| 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 HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$273.20 |
| Max. Negotiated Rate |
$1,161.10 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.40
|
| Rate for Payer: EPIC Health Plan Senior |
$546.40
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$867.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$805.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.84
|
| Rate for Payer: Multiplan Commercial |
$1,092.80
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
|
|
HC GI PROTEIN LOSS
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 78282
|
| Hospital Charge Code |
909301367
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$1,723.45 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,723.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$876.56
|
| Rate for Payer: Blue Shield of California Commercial |
$871.51
|
| Rate for Payer: Blue Shield of California Commercial |
$575.09
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cigna of CA HMO |
$874.24
|
| Rate for Payer: Cigna of CA PPO |
$1,010.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$867.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,092.80
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$819.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$819.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GIVEN ENDO IMAGING
|
Facility
|
OP
|
$8,616.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
906776499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,723.20
|
| Rate for Payer: Adventist Health Commercial |
$1,915.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,528.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,145.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cash Price |
$3,877.20
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cash Price |
$4,309.65
|
| Rate for Payer: Cigna of CA HMO |
$6,129.28
|
| Rate for Payer: Cigna of CA HMO |
$5,514.24
|
| Rate for Payer: Cigna of CA PPO |
$7,086.98
|
| Rate for Payer: Cigna of CA PPO |
$6,375.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,703.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,031.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$7,323.60
|
| Rate for Payer: Galaxy Health WC |
$8,140.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,746.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,169.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,351.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,351.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,081.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,471.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,528.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,528.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,067.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,298.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$7,661.60
|
| Rate for Payer: Multiplan Commercial |
$6,892.80
|
| Rate for Payer: Networks By Design Commercial |
$6,225.05
|
| Rate for Payer: Networks By Design Commercial |
$5,600.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,140.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,323.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,746.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,169.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,788.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,308.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
