|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,912.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9,530.97
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,147.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,912.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9,530.97
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,147.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,530.97
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,376.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,530.97
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,376.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.80
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,159.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,599.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.80
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,207.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,159.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,599.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,123.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.20
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,123.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.20
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,683.68 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,990.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,123.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,157.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,056.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,683.68 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,990.52
|
| Rate for Payer: Blue Shield of California Commercial |
$4,123.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,157.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,056.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.40
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,803.54 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$2,257.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,203.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,680.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,567.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,836.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,854.90
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,202.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,803.54 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$2,257.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,203.42
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,680.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,567.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,836.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,854.90
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,202.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.40
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$871.15 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,806.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,862.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,064.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,729.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$871.15 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,806.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,862.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,064.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,729.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,937.49 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,441.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,744.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,008.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,366.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,744.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,937.49 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,441.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,744.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,008.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,366.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,744.63
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,465.75 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,379.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6,038.26
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,780.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,442.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
