|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,454.28 |
| Max. Negotiated Rate |
$6,744.60 |
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,401.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,792.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,776.98
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,537.51
|
| Rate for Payer: InnovAge PACE Commercial |
$3,747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,072.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,997.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,454.28 |
| Max. Negotiated Rate |
$6,744.60 |
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,401.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,792.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,776.98
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,537.51
|
| Rate for Payer: InnovAge PACE Commercial |
$3,747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,072.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,997.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$6,744.60 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,792.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,776.98
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,498.80
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$4,871.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$6,744.60 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,792.86
|
| Rate for Payer: Blue Shield of California EPN |
$3,776.98
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,498.80
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$4,871.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$6,403.50 |
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.90
|
| Rate for Payer: Blue Shield of California EPN |
$3,585.96
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$4,624.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,330.16 |
| Max. Negotiated Rate |
$6,403.50 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,178.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.90
|
| Rate for Payer: Blue Shield of California EPN |
$3,585.96
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,557.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,846.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,330.16 |
| Max. Negotiated Rate |
$6,403.50 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,178.64
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.90
|
| Rate for Payer: Blue Shield of California EPN |
$3,585.96
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: InnovAge PACE Commercial |
$3,557.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,846.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$6,403.50 |
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,499.90
|
| Rate for Payer: Blue Shield of California EPN |
$3,585.96
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$4,624.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,059.18 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,485.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7,220.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: InnovAge PACE Commercial |
$4,670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,829.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,736.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,220.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.20
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$6,071.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,059.18 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$3,829.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,005.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,485.97
|
| Rate for Payer: Blue Shield of California Commercial |
$7,220.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,939.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: InnovAge PACE Commercial |
$4,670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,829.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,538.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,538.70
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,736.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,220.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,707.86
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.20
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$6,071.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.58
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
915355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.12 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,061.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.58
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,079.71
|
| Rate for Payer: InnovAge PACE Commercial |
$904.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health System MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.12 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$741.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,061.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.58
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,536.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,079.71
|
| Rate for Payer: InnovAge PACE Commercial |
$904.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,265.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,265.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health System MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Adventist Health Commercial |
$361.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.58
|
| Rate for Payer: Blue Shield of California EPN |
$911.23
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Senior |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$688.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,119.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$1,175.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$678.54
|
| Rate for Payer: United Healthcare All Other HMO |
$660.46
|
| Rate for Payer: United Healthcare HMO Rider |
$646.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$592.12
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,882.33 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,168.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6,803.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,434.37
|
| Rate for Payer: InnovAge PACE Commercial |
$4,400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,608.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,803.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$5,720.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
915355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$1,760.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,803.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,353.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$5,720.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,882.33 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Adventist Health Commercial |
$3,608.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,600.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,168.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6,803.17
|
| Rate for Payer: Blue Shield of California EPN |
$4,435.70
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Cash Price |
$4,840.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,480.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,434.37
|
| Rate for Payer: InnovAge PACE Commercial |
$4,400.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,898.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,447.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,608.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,160.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,160.70
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,303.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3,215.01
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,882.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,594.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 1 CHNL
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
909100450
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$325.91 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$881.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,564.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,605.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.91
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,322.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,181.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$881.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$934.44
|
| Rate for Payer: Riverside University Health System MISP |
$969.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,924.47 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$881.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,564.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,924.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$930.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,322.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,027.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,181.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$881.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$934.44
|
| Rate for Payer: Riverside University Health System MISP |
$969.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY 2-12 CHNLS
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
909100451
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,594.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
OP
|
$2,576.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$4,614.47 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$881.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,564.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,614.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$936.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,563.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,022.67
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: Cigna of CA HMO |
$1,648.64
|
| Rate for Payer: Cigna of CA PPO |
$1,906.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,394.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: InnovAge PACE Commercial |
$1,322.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,181.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$881.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
| Rate for Payer: Prime Health Services Medicare |
$934.44
|
| Rate for Payer: Riverside University Health System MISP |
$969.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,545.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,545.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,288.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,288.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,288.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
