|
HC EXCISION TONGUE LESION W/O CLOSURE
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
900501147
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,306.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC EXCISION VAGINAL SEPTUM
|
Facility
|
OP
|
$11,566.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
900500130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$278.88 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,313.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,204.70
|
| Rate for Payer: Cash Price |
$5,204.70
|
| Rate for Payer: Cash Price |
$5,204.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,252.80
|
| Rate for Payer: Cigna of CA HMO |
$7,402.24
|
| Rate for Payer: Cigna of CA PPO |
$8,558.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$9,831.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$278.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,714.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$8,674.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$7,517.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$9,831.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,939.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EXCISION VAGINAL SEPTUM
|
Facility
|
IP
|
$11,566.00
|
|
|
Service Code
|
CPT 57130
|
| Hospital Charge Code |
900500130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,313.20 |
| Max. Negotiated Rate |
$10,409.40 |
| Rate for Payer: Adventist Health Commercial |
$2,313.20
|
| Rate for Payer: Cash Price |
$5,204.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,252.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,626.40
|
| Rate for Payer: Galaxy Health WC |
$9,831.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,409.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,714.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,406.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,159.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,313.20
|
| Rate for Payer: Multiplan Commercial |
$8,674.50
|
| Rate for Payer: Networks By Design Commercial |
$7,517.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,831.10
|
|
|
HC EXC SKIN LESION 0.6-1.0 CM
|
Facility
|
IP
|
$6,131.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
902890016
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,226.20 |
| Max. Negotiated Rate |
$5,517.90 |
| Rate for Payer: Adventist Health Commercial |
$1,226.20
|
| Rate for Payer: Cash Price |
$2,758.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,904.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,452.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,452.40
|
| Rate for Payer: Galaxy Health WC |
$5,211.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,678.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,517.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,335.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,795.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.20
|
| Rate for Payer: Multiplan Commercial |
$4,598.25
|
| Rate for Payer: Networks By Design Commercial |
$3,985.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,211.35
|
|
|
HC EXC SKIN LESION 0.6-1.0 CM
|
Facility
|
OP
|
$6,131.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
902890016
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$2,513.71
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$2,758.95
|
| Rate for Payer: Cash Price |
$2,758.95
|
| Rate for Payer: Cash Price |
$2,758.95
|
| Rate for Payer: Cash Price |
$2,758.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,904.80
|
| Rate for Payer: Cigna of CA HMO |
$3,923.84
|
| Rate for Payer: Cigna of CA PPO |
$4,536.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$5,211.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,678.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,517.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,226.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$4,598.25
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$3,985.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$5,211.35
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,678.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,678.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC EXC SKIN LESION 1.1-2.0 CM
|
Facility
|
OP
|
$6,744.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
902890017
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$6,069.60 |
| Rate for Payer: Adventist Health Commercial |
$2,765.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,395.20
|
| Rate for Payer: Cigna of CA HMO |
$4,316.16
|
| Rate for Payer: Cigna of CA PPO |
$4,990.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,046.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,069.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,498.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,058.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,383.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,732.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,046.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,046.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC EXC SKIN LESION 1.1-2.0 CM
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
902890017
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,348.80 |
| Max. Negotiated Rate |
$6,069.60 |
| Rate for Payer: Adventist Health Commercial |
$1,348.80
|
| Rate for Payer: Cash Price |
$3,034.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,395.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,697.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,697.60
|
| Rate for Payer: Galaxy Health WC |
$5,732.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,046.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,069.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,498.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,569.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,174.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.80
|
| Rate for Payer: Multiplan Commercial |
$5,058.00
|
| Rate for Payer: Networks By Design Commercial |
$4,383.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,732.40
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$8,125.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$7,312.50 |
| Rate for Payer: Adventist Health Commercial |
$3,331.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,387.03
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,200.00
|
| Rate for Payer: Cigna of CA PPO |
$6,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$6,906.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,312.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,419.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$6,093.75
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$5,281.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Preferred Health Network WC |
$2,435.74
|
| Rate for Payer: Prime Health Services Commercial |
$6,906.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
OP
|
$8,125.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$7,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,625.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,387.03
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,500.00
|
| Rate for Payer: Cigna of CA HMO |
$5,200.00
|
| Rate for Payer: Cigna of CA PPO |
$6,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$6,906.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,312.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,419.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$6,093.75
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$5,281.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Preferred Health Network WC |
$2,435.74
|
| Rate for Payer: Prime Health Services Commercial |
$6,906.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,062.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$8,125.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,625.00 |
| Max. Negotiated Rate |
$7,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,625.00
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,250.00
|
| Rate for Payer: Galaxy Health WC |
$6,906.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,419.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,095.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,029.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$6,093.75
|
| Rate for Payer: Networks By Design Commercial |
$5,281.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,906.25
|
|
|
HC EXCSN EXT THROMBOTC HEMORRHOID
|
Facility
|
IP
|
$8,125.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
900501158
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,625.00 |
| Max. Negotiated Rate |
$7,312.50 |
| Rate for Payer: Adventist Health Commercial |
$1,625.00
|
| Rate for Payer: Cash Price |
$3,656.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,250.00
|
| Rate for Payer: Galaxy Health WC |
$6,906.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,419.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,095.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,029.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,625.00
|
| Rate for Payer: Multiplan Commercial |
$6,093.75
|
| Rate for Payer: Networks By Design Commercial |
$5,281.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,906.25
|
|
|
HC EXCSN,TUMOR, FOOT, S/C TISSUE
|
Facility
|
IP
|
$12,464.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
902890285
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,492.80 |
| Max. Negotiated Rate |
$11,217.60 |
| Rate for Payer: Adventist Health Commercial |
$2,492.80
|
| Rate for Payer: Cash Price |
$5,608.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,971.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,985.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,985.60
|
| Rate for Payer: Galaxy Health WC |
$10,594.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,478.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,217.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,748.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,715.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.80
|
| Rate for Payer: Multiplan Commercial |
$9,348.00
|
| Rate for Payer: Networks By Design Commercial |
$8,101.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,594.40
|
|
|
HC EXCSN,TUMOR, FOOT, S/C TISSUE
|
Facility
|
OP
|
$12,464.00
|
|
|
Service Code
|
CPT 28043
|
| Hospital Charge Code |
902890285
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,217.60 |
| Rate for Payer: Adventist Health Commercial |
$5,110.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$5,608.80
|
| Rate for Payer: Cash Price |
$5,608.80
|
| Rate for Payer: Cash Price |
$5,608.80
|
| Rate for Payer: Cash Price |
$5,608.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,971.20
|
| Rate for Payer: Cigna of CA HMO |
$7,976.96
|
| Rate for Payer: Cigna of CA PPO |
$9,223.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$10,594.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,478.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,217.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$573.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,492.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$9,348.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$8,101.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$10,594.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,478.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,478.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC EXC THIGH/KNEE LES SC GT 3 CM
|
Facility
|
OP
|
$11,955.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
904000007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$593.61 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,391.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,636.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$5,794.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,379.75
|
| Rate for Payer: Cash Price |
$5,379.75
|
| Rate for Payer: Cash Price |
$5,379.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,564.00
|
| Rate for Payer: Cigna of CA HMO |
$7,651.20
|
| Rate for Payer: Cigna of CA PPO |
$8,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$10,161.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,759.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$593.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: InnovAge PACE Commercial |
$5,454.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,973.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,391.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,872.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$8,966.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$7,770.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Preferred Health Network WC |
$5,912.39
|
| Rate for Payer: Prime Health Services Commercial |
$10,161.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,854.71
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Riverside University Health System MISP |
$4,000.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,173.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC EXC THIGH/KNEE LES SC GT 3 CM
|
Facility
|
IP
|
$11,955.00
|
|
|
Service Code
|
CPT 27337
|
| Hospital Charge Code |
904000007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,391.00 |
| Max. Negotiated Rate |
$10,759.50 |
| Rate for Payer: Adventist Health Commercial |
$2,391.00
|
| Rate for Payer: Cash Price |
$5,379.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,564.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,782.00
|
| Rate for Payer: Galaxy Health WC |
$10,161.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,173.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,759.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,973.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,554.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,400.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,391.00
|
| Rate for Payer: Multiplan Commercial |
$8,966.25
|
| Rate for Payer: Networks By Design Commercial |
$7,770.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,161.75
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.27
|
| Rate for Payer: Blue Shield of California Commercial |
$130.50
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC EXC TST BRNCHSPSM WO EC RCRDG
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
900894619
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$96.75
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Central Health Plan Commercial |
$436.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.00
|
| Rate for Payer: EPIC Health Plan Senior |
$218.00
|
| Rate for Payer: Galaxy Health WC |
$463.25
|
| Rate for Payer: Global Benefits Group Commercial |
$327.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
| Rate for Payer: Networks By Design Commercial |
$354.25
|
| Rate for Payer: Prime Health Services Commercial |
$463.25
|
|
|
HC EXERCISE TEST BRONCHOSPASM
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
900894620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$370.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.08
|
| Rate for Payer: Blue Shield of California Commercial |
$330.81
|
| Rate for Payer: Blue Shield of California EPN |
$216.37
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Cash Price |
$245.25
|
| Rate for Payer: Central Health Plan Commercial |
$436.00
|
| Rate for Payer: Cigna of CA HMO |
$348.80
|
| Rate for Payer: Cigna of CA PPO |
$403.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$463.25
|
| Rate for Payer: Global Benefits Group Commercial |
$327.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$490.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$363.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
| Rate for Payer: Networks By Design Commercial |
$354.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$463.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$327.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$327.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC EX FOR SPEECH DEVICE RX ADDL
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
905601817
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$128.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$235.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA HMO |
$200.96
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$266.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.34
|
| Rate for Payer: InnovAge PACE Commercial |
$157.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Riverside University Health System MISP |
$125.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$266.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.90
|
| Rate for Payer: Vantage Medical Group Senior |
$266.90
|
|
|
HC EX MALIGNANT LES 1.1 - 2.0 CM
|
Facility
|
IP
|
$2,422.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
902890378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.40 |
| Max. Negotiated Rate |
$2,179.80 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,937.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$968.80
|
| Rate for Payer: EPIC Health Plan Senior |
$968.80
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,179.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$922.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,499.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.40
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
|
|
HC EX MALIGNANT LES 1.1 - 2.0 CM
|
Facility
|
OP
|
$2,422.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
902890378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$484.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Cash Price |
$1,089.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,937.60
|
| Rate for Payer: Cigna of CA HMO |
$1,550.08
|
| Rate for Payer: Cigna of CA PPO |
$1,792.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,058.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,453.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,179.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,615.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,816.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,574.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,058.70
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,453.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC EX MALIGNANT LES 2.1 - 3.0 CM
|
Facility
|
IP
|
$4,202.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
900501792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$3,781.80 |
| Rate for Payer: Adventist Health Commercial |
$840.40
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,680.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,680.80
|
| Rate for Payer: Galaxy Health WC |
$3,571.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,781.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,601.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.40
|
| Rate for Payer: Multiplan Commercial |
$3,151.50
|
| Rate for Payer: Networks By Design Commercial |
$2,731.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,571.70
|
|
|
HC EX MALIGNANT LES 2.1 - 3.0 CM
|
Facility
|
OP
|
$4,202.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
900501792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$289.44 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$840.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,361.60
|
| Rate for Payer: Cigna of CA HMO |
$2,689.28
|
| Rate for Payer: Cigna of CA PPO |
$3,109.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$3,571.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,521.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,781.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,802.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,151.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,731.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$3,571.70
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,521.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
