|
HC BOOT REGULAR TRACTION
|
Facility
|
OP
|
$412.90
|
|
| Hospital Charge Code |
901698331
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.58 |
| Max. Negotiated Rate |
$371.61 |
| Rate for Payer: Adventist Health Commercial |
$82.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.18
|
| Rate for Payer: Blue Shield of California Commercial |
$261.78
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$185.80
|
| Rate for Payer: Central Health Plan Commercial |
$330.32
|
| Rate for Payer: Cigna of CA HMO |
$264.26
|
| Rate for Payer: Cigna of CA PPO |
$305.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$350.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$350.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$350.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.16
|
| Rate for Payer: EPIC Health Plan Senior |
$165.16
|
| Rate for Payer: Galaxy Health WC |
$350.96
|
| Rate for Payer: Global Benefits Group Commercial |
$247.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$289.03
|
| Rate for Payer: Multiplan Commercial |
$309.68
|
| Rate for Payer: Networks By Design Commercial |
$268.38
|
| Rate for Payer: Prime Health Services Commercial |
$350.96
|
| Rate for Payer: Riverside University Health System MISP |
$165.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.45
|
| Rate for Payer: United Healthcare All Other HMO |
$206.45
|
| Rate for Payer: United Healthcare HMO Rider |
$206.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$350.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$350.96
|
| Rate for Payer: Vantage Medical Group Senior |
$350.96
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Adventist Health Commercial |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.39
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$89.56
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: Riverside University Health System MISP |
$71.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.26
|
| Rate for Payer: Vantage Medical Group Senior |
$152.26
|
|
|
HC BOOT WALKER LARGE CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606735
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Adventist Health Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$116.43
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
|
|
HC BOOT WALKER LRG STANDARD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER LRG STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.59
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.59
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER MED STANDARD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Adventist Health Commercial |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.39
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$89.56
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: Riverside University Health System MISP |
$71.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.26
|
| Rate for Payer: Vantage Medical Group Senior |
$152.26
|
|
|
HC BOOT WALKER SMALL CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606733
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Adventist Health Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$116.43
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
|
|
HC BOOT WALKER SM TALL CLOSED
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$221.81 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.59
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER SM TALL CLOSED
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4387
|
| Hospital Charge Code |
901698895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
OP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$451.14 |
| Rate for Payer: Adventist Health Commercial |
$73.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$451.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.39
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$89.56
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: Riverside University Health System MISP |
$71.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.26
|
| Rate for Payer: Vantage Medical Group Senior |
$152.26
|
|
|
HC BOOT WALKER STANDARD CLOSED HEEL
|
Facility
|
IP
|
$179.13
|
|
|
Service Code
|
CPT L2112
|
| Hospital Charge Code |
901606734
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$161.22 |
| Rate for Payer: Adventist Health Commercial |
$35.83
|
| Rate for Payer: Blue Shield of California Commercial |
$143.66
|
| Rate for Payer: Blue Shield of California EPN |
$90.28
|
| Rate for Payer: Cash Price |
$80.61
|
| Rate for Payer: Central Health Plan Commercial |
$143.30
|
| Rate for Payer: Cigna of CA HMO |
$125.39
|
| Rate for Payer: Cigna of CA PPO |
$125.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.65
|
| Rate for Payer: EPIC Health Plan Senior |
$71.65
|
| Rate for Payer: Galaxy Health WC |
$152.26
|
| Rate for Payer: Global Benefits Group Commercial |
$107.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.83
|
| Rate for Payer: Multiplan Commercial |
$134.35
|
| Rate for Payer: Networks By Design Commercial |
$116.43
|
| Rate for Payer: Prime Health Services Commercial |
$152.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.23
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$64.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.67
|
|
|
HC BOOT WALKER X-SM STNDRD TALL
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$189.35 |
| Rate for Payer: Adventist Health Commercial |
$66.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.59
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$81.31
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC BOOT WALKER X-SM STNDRD TALL
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
901698898
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$130.41
|
| Rate for Payer: Blue Shield of California EPN |
$81.96
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: Cigna of CA HMO |
$113.83
|
| Rate for Payer: Cigna of CA PPO |
$113.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.03
|
| Rate for Payer: United Healthcare All Other HMO |
$59.40
|
| Rate for Payer: United Healthcare HMO Rider |
$58.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.25
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
IP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
|
|
HC BORN ON ARRIVAL KIT
|
Facility
|
OP
|
$44.44
|
|
| Hospital Charge Code |
901698278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Adventist Health Commercial |
$8.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.85
|
| Rate for Payer: Blue Shield of California Commercial |
$28.17
|
| Rate for Payer: Blue Shield of California EPN |
$17.73
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$28.44
|
| Rate for Payer: Cigna of CA PPO |
$32.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Senior |
$17.78
|
| Rate for Payer: Galaxy Health WC |
$37.77
|
| Rate for Payer: Global Benefits Group Commercial |
$26.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.11
|
| Rate for Payer: Multiplan Commercial |
$33.33
|
| Rate for Payer: Networks By Design Commercial |
$28.89
|
| Rate for Payer: Prime Health Services Commercial |
$37.77
|
| Rate for Payer: Riverside University Health System MISP |
$17.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.22
|
| Rate for Payer: United Healthcare All Other HMO |
$22.22
|
| Rate for Payer: United Healthcare HMO Rider |
$22.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.77
|
| Rate for Payer: Vantage Medical Group Senior |
$37.77
|
|
|
HC BOTOX INJECTION
|
Facility
|
IP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$897.40 |
| Max. Negotiated Rate |
$4,038.30 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.80
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,038.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,647.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
|
|
HC BOTOX INJECTION
|
Facility
|
OP
|
$4,487.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906764999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$418.15 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$897.40
|
| Rate for Payer: Adventist Health Commercial |
$599.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$2,019.15
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Cash Price |
$1,349.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,398.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,589.60
|
| Rate for Payer: Cigna of CA HMO |
$1,918.72
|
| Rate for Payer: Cigna of CA HMO |
$2,871.68
|
| Rate for Payer: Cigna of CA PPO |
$3,320.38
|
| Rate for Payer: Cigna of CA PPO |
$2,218.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,098.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$3,813.95
|
| Rate for Payer: Galaxy Health WC |
$2,548.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,692.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,698.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,038.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,903.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,849.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$599.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,365.25
|
| Rate for Payer: Multiplan Commercial |
$2,248.50
|
| Rate for Payer: Networks By Design Commercial |
$2,916.55
|
| Rate for Payer: Networks By Design Commercial |
$1,948.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,548.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,692.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,243.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,499.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
IP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$643.40 |
| Max. Negotiated Rate |
$2,895.30 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,573.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,251.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,286.80
|
| Rate for Payer: Galaxy Health WC |
$2,734.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,895.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,042.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.40
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
| Rate for Payer: Networks By Design Commercial |
$2,091.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,734.45
|
|
|
HC BOTOX INJECT SALIVARY GLAND
|
Facility
|
OP
|
$3,217.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
909020109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$643.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$394.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Cash Price |
$1,447.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,573.60
|
| Rate for Payer: Cigna of CA HMO |
$2,058.88
|
| Rate for Payer: Cigna of CA PPO |
$2,380.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,251.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$2,734.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,895.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,042.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$163.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$2,412.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$2,091.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$2,734.45
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,608.50
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
IP
|
$203.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Adventist Health Commercial |
$40.60
|
| Rate for Payer: Blue Shield of California Commercial |
$162.81
|
| Rate for Payer: Blue Shield of California EPN |
$102.31
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Central Health Plan Commercial |
$162.40
|
| Rate for Payer: Cigna of CA HMO |
$142.10
|
| Rate for Payer: Cigna of CA PPO |
$142.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.60
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: Networks By Design Commercial |
$131.95
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$74.16
|
| Rate for Payer: United Healthcare HMO Rider |
$72.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.48
|
|
|
HC BRACE ANKLE GEL REG BLUE
|
Facility
|
OP
|
$203.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901698724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Adventist Health Commercial |
$83.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.09
|
| Rate for Payer: Blue Shield of California Commercial |
$162.81
|
| Rate for Payer: Blue Shield of California EPN |
$102.31
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Central Health Plan Commercial |
$162.40
|
| Rate for Payer: Cigna of CA HMO |
$142.10
|
| Rate for Payer: Cigna of CA PPO |
$142.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.20
|
| Rate for Payer: EPIC Health Plan Senior |
$81.20
|
| Rate for Payer: Galaxy Health WC |
$172.55
|
| Rate for Payer: Global Benefits Group Commercial |
$121.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$128.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.10
|
| Rate for Payer: Multiplan Commercial |
$152.25
|
| Rate for Payer: Networks By Design Commercial |
$101.50
|
| Rate for Payer: Prime Health Services Commercial |
$172.55
|
| Rate for Payer: Riverside University Health System MISP |
$81.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.19
|
| Rate for Payer: United Healthcare All Other HMO |
$74.16
|
| Rate for Payer: United Healthcare HMO Rider |
$72.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.55
|
| Rate for Payer: Vantage Medical Group Senior |
$172.55
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
IP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Adventist Health Commercial |
$35.97
|
| Rate for Payer: Blue Shield of California Commercial |
$144.22
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Central Health Plan Commercial |
$143.86
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.97
|
| Rate for Payer: Multiplan Commercial |
$134.87
|
| Rate for Payer: Networks By Design Commercial |
$116.89
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
|
|
HC BRACE ANKLE GEL UNIV
|
Facility
|
OP
|
$179.83
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
901602873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Adventist Health Commercial |
$73.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.61
|
| Rate for Payer: Blue Shield of California Commercial |
$144.22
|
| Rate for Payer: Blue Shield of California EPN |
$90.63
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Cash Price |
$80.92
|
| Rate for Payer: Central Health Plan Commercial |
$143.86
|
| Rate for Payer: Cigna of CA HMO |
$125.88
|
| Rate for Payer: Cigna of CA PPO |
$125.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.93
|
| Rate for Payer: EPIC Health Plan Senior |
$71.93
|
| Rate for Payer: Galaxy Health WC |
$152.86
|
| Rate for Payer: Global Benefits Group Commercial |
$107.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.88
|
| Rate for Payer: Multiplan Commercial |
$134.87
|
| Rate for Payer: Networks By Design Commercial |
$89.92
|
| Rate for Payer: Prime Health Services Commercial |
$152.86
|
| Rate for Payer: Riverside University Health System MISP |
$71.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.49
|
| Rate for Payer: United Healthcare All Other HMO |
$65.69
|
| Rate for Payer: United Healthcare HMO Rider |
$64.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.86
|
| Rate for Payer: Vantage Medical Group Senior |
$152.86
|
|
