|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$555.84 |
| Max. Negotiated Rate |
$1,968.60 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,401.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,781.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,174.21
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$631.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,470.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,366.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,470.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,366.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.84
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Networks By Design Commercial |
$1,505.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,909.38
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,496.88 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,258.94
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,066.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Networks By Design Commercial |
$1,909.38
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,496.88 |
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,778.07
|
| Rate for Payer: Blue Shield of California Commercial |
$1,489.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,258.94
|
| Rate for Payer: Cash Price |
$1,321.88
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,865.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,066.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,733.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,350.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.96 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$216.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.20
|
| Rate for Payer: Blue Shield of California Commercial |
$268.20
|
| Rate for Payer: Blue Shield of California Commercial |
$406.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$335.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.48
|
| Rate for Payer: Blue Shield of California Commercial |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$64.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.48
|
| Rate for Payer: Blue Shield of California Commercial |
$98.43
|
| Rate for Payer: Blue Shield of California Commercial |
$64.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$661.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Senior |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$600.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$557.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,800.14 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,800.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,381.53
|
| Rate for Payer: Blue Shield of California Commercial |
$435.64
|
| Rate for Payer: Blue Shield of California Commercial |
$658.66
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$661.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$575.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$600.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$650.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
OP
|
$4,739.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$947.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,028.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,606.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,554.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$2,132.55
|
| Rate for Payer: Cash Price |
$2,132.55
|
| Rate for Payer: Cash Price |
$2,132.55
|
| Rate for Payer: Cigna of CA HMO |
$3,032.96
|
| Rate for Payer: Cigna of CA PPO |
$3,506.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,028.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,028.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,028.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,317.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.60
|
| Rate for Payer: Galaxy Health WC |
$4,028.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,843.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,009.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,720.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,796.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,317.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,317.30
|
| Rate for Payer: Multiplan Commercial |
$3,791.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$3,080.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,028.15
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,843.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,369.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,028.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,028.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,028.15
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
IP
|
$4,739.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$947.80 |
| Max. Negotiated Rate |
$4,028.15 |
| Rate for Payer: Adventist Health Commercial |
$947.80
|
| Rate for Payer: Cash Price |
$2,132.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,317.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,895.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,895.60
|
| Rate for Payer: Galaxy Health WC |
$4,028.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,843.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,009.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,796.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,137.36
|
| Rate for Payer: Multiplan Commercial |
$3,791.20
|
| Rate for Payer: Networks By Design Commercial |
$3,080.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,028.15
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Blue Shield of California Commercial |
$29.50
|
| Rate for Payer: Blue Shield of California Commercial |
$108.33
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California Commercial |
$163.79
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.00
|
| Rate for Payer: EPIC Health Plan Senior |
$76.00
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$189.01 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Adventist Health Commercial |
$38.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.01
|
| Rate for Payer: Blue Shield of California Commercial |
$132.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.56
|
| Rate for Payer: Blue Shield of California Commercial |
$87.59
|
| Rate for Payer: Blue Shield of California Commercial |
$70.40
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Cigna of CA HMO |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Cigna of CA PPO |
$140.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Galaxy Health WC |
$161.50
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Global Benefits Group Commercial |
$114.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$123.50
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Commercial |
$161.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| 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 |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| 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 |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
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 PROSTH ADD SHOULDER HAMESS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
905355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
905355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$243.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
915355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
