|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.23
|
| Rate for Payer: Blue Shield of California Commercial |
$25.88
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.35
|
| Rate for Payer: InnovAge PACE Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE INFLUENZA GT 3 YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
941002039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$47.15
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC VACCINE INFLUENZA PRESERV FREE GT 3YR
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
943102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$47.15
|
| Rate for Payer: Blue Shield of California EPN |
$30.74
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
|
|
HC VACCINE INFLUENZA PRESERV FREE GT 3YR
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
943102039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.23
|
| Rate for Payer: Blue Shield of California Commercial |
$25.88
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$42.70
|
| Rate for Payer: Cigna of CA PPO |
$42.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.35
|
| Rate for Payer: InnovAge PACE Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$30.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.89
|
| Rate for Payer: United Healthcare All Other HMO |
$22.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
949000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$101.81
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$262.07 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$101.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health System MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
941000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$101.81
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
949000405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$262.07 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$101.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health System MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$101.81
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23 SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
942100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$262.07 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$101.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health System MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINE PNEUMOCOCCAL 23SDV
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
943100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$181.80 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Blue Shield of California Commercial |
$156.15
|
| Rate for Payer: Blue Shield of California EPN |
$101.81
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
|
|
HC VACCINE PNEUMOCOCCAL 23SDV
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
943100405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$262.07 |
| Rate for Payer: Adventist Health Commercial |
$40.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$151.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.02
|
| Rate for Payer: Blue Shield of California Commercial |
$154.55
|
| Rate for Payer: Blue Shield of California EPN |
$140.50
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Cash Price |
$111.10
|
| Rate for Payer: Central Health Plan Commercial |
$161.60
|
| Rate for Payer: Cigna of CA HMO |
$141.40
|
| Rate for Payer: Cigna of CA PPO |
$141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$171.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Senior |
$80.80
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$181.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$133.47
|
| Rate for Payer: InnovAge PACE Commercial |
$101.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$141.40
|
| Rate for Payer: Multiplan Commercial |
$151.50
|
| Rate for Payer: Networks By Design Commercial |
$101.00
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Riverside University Health System MISP |
$80.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.81
|
| Rate for Payer: United Healthcare All Other HMO |
$73.79
|
| Rate for Payer: United Healthcare HMO Rider |
$72.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$171.70
|
| Rate for Payer: Vantage Medical Group Senior |
$171.70
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$0.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Medicare |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC VACCINIA VRS VAC 0.3 ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
948000201
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
|
|
HC VAD ABIOMED IMPELLA 2.5 CATH
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
906812386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28,987.50
|
| Rate for Payer: Blue Shield of California EPN |
$18,900.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,000.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,500.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
|
|
HC VAD ABIOMED IMPELLA 2.5 CATH
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
906812386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,122.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,763.75
|
| Rate for Payer: Blue Shield of California Commercial |
$28,987.50
|
| Rate for Payer: Blue Shield of California EPN |
$18,900.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,000.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,875.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,750.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,250.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: Riverside University Health System MISP |
$15,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$31,875.00
|
|
|
HC VAD ABIOMED IMPELLA RP
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
906812562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28,987.50
|
| Rate for Payer: Blue Shield of California EPN |
$18,900.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,000.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,500.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
|
|
HC VAD ABIOMED IMPELLA RP
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
906812562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,500.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Adventist Health Commercial |
$7,500.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,625.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,125.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17,122.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20,763.75
|
| Rate for Payer: Blue Shield of California Commercial |
$28,987.50
|
| Rate for Payer: Blue Shield of California EPN |
$18,900.00
|
| Rate for Payer: Cash Price |
$20,625.00
|
| Rate for Payer: Central Health Plan Commercial |
$30,000.00
|
| Rate for Payer: Cigna of CA HMO |
$26,250.00
|
| Rate for Payer: Cigna of CA PPO |
$26,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,875.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,875.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,000.00
|
| Rate for Payer: Galaxy Health WC |
$31,875.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22,500.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,750.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,287.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,250.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,250.00
|
| Rate for Payer: Multiplan Commercial |
$28,125.00
|
| Rate for Payer: Networks By Design Commercial |
$18,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,875.00
|
| Rate for Payer: Riverside University Health System MISP |
$15,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,500.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,500.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,073.75
|
| Rate for Payer: United Healthcare All Other HMO |
$13,698.75
|
| Rate for Payer: United Healthcare HMO Rider |
$13,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,281.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,875.00
|
| Rate for Payer: Vantage Medical Group Senior |
$31,875.00
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$871.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,029.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.60
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,029.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,298.99
|
| Rate for Payer: Blue Shield of California EPN |
$848.27
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC VAD/CATH DECLOT THROMBOLYTIC AGENT
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
907201300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
