|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,515.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL ADD-ON
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
909081856
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,187.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,983.50
|
| 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: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,381.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,381.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,784.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,784.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,591.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$3,381.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,381.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.74 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,515.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,515.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.54 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$246.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$4,377.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$875.40 |
| Max. Negotiated Rate |
$3,939.30 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,750.80
|
| Rate for Payer: Galaxy Health WC |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,919.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,667.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,709.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$4,377.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$875.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$1,402.00
|
| 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 |
$2,407.35
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Cash Price |
$2,407.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,501.60
|
| Rate for Payer: Cigna of CA HMO |
$2,801.28
|
| Rate for Payer: Cigna of CA PPO |
$3,238.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,720.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,939.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,919.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$3,282.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,845.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,720.45
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,626.20
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$254.22 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$1,402.00
|
| 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 |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,515.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$4,991.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.20 |
| Max. Negotiated Rate |
$4,491.90 |
| Rate for Payer: Adventist Health Commercial |
$998.20
|
| Rate for Payer: Cash Price |
$2,745.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.40
|
| Rate for Payer: Galaxy Health WC |
$4,242.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,994.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,491.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,901.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,089.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.20
|
| Rate for Payer: Multiplan Commercial |
$3,743.25
|
| Rate for Payer: Networks By Design Commercial |
$3,244.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,242.35
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$4,991.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$998.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$879.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| 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 |
$1,402.00
|
| 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 |
$2,745.05
|
| Rate for Payer: Cash Price |
$2,745.05
|
| Rate for Payer: Cash Price |
$2,745.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,992.80
|
| Rate for Payer: Cigna of CA HMO |
$3,194.24
|
| Rate for Payer: Cigna of CA PPO |
$3,693.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$4,242.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,994.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,491.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,319.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,179.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$3,743.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$3,244.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$879.92
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$4,242.35
|
| Rate for Payer: Prime Health Services Medicare |
$932.72
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$967.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,994.60
|
| 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 |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.60 |
| Max. Negotiated Rate |
$3,580.20 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,591.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,591.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,515.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,462.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.22 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Cash Price |
$2,187.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,182.40
|
| Rate for Payer: Cigna of CA HMO |
$2,545.92
|
| Rate for Payer: Cigna of CA PPO |
$2,943.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,381.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,386.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,580.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$238.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,653.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,585.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,381.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,386.80
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
OP
|
$6,578.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.79 |
| Max. Negotiated Rate |
$5,920.20 |
| Rate for Payer: Adventist Health Commercial |
$1,315.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$3,617.90
|
| Rate for Payer: Cash Price |
$3,617.90
|
| Rate for Payer: Cash Price |
$3,617.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,262.40
|
| Rate for Payer: Cigna of CA HMO |
$4,209.92
|
| Rate for Payer: Cigna of CA PPO |
$4,867.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$5,591.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,920.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$345.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$4,933.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$4,275.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,591.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,946.80
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
IP
|
$6,578.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,315.60 |
| Max. Negotiated Rate |
$5,920.20 |
| Rate for Payer: Adventist Health Commercial |
$1,315.60
|
| Rate for Payer: Cash Price |
$3,617.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,262.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,631.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,631.20
|
| Rate for Payer: Galaxy Health WC |
$5,591.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,946.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,920.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,506.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,315.60
|
| Rate for Payer: Multiplan Commercial |
$4,933.50
|
| Rate for Payer: Networks By Design Commercial |
$4,275.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,591.30
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,196.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| Rate for Payer: Cash Price |
$3,289.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,392.00
|
| Rate for Payer: Galaxy Health WC |
$5,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,382.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,988.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,278.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,701.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
| Rate for Payer: Networks By Design Commercial |
$3,887.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,083.00
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$3,289.00
|
| Rate for Payer: Cash Price |
$3,289.00
|
| Rate for Payer: Cash Price |
$3,289.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,784.00
|
| Rate for Payer: Cigna of CA HMO |
$3,827.20
|
| Rate for Payer: Cigna of CA PPO |
$4,425.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$5,083.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,382.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,988.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$3,887.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,083.00
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,588.00
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.20 |
| Max. Negotiated Rate |
$2,957.40 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,314.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,314.40
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,034.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
|
|
HC INJ NEURO SUB W WO THRPTC SUB EPDRL, LMBR, SCRL
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
909000282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$657.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,131.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| 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 |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Cash Price |
$1,807.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,628.80
|
| Rate for Payer: Cigna of CA HMO |
$2,103.04
|
| Rate for Payer: Cigna of CA PPO |
$2,431.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,793.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,971.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,957.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,191.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,464.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,135.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,793.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,971.60
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,705.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,544.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,106.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$443.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,704.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,114.78
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$1,797.12
|
| Rate for Payer: Cigna of CA PPO |
$2,077.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,386.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,386.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,404.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,965.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,965.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,123.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,684.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,684.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,386.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,386.80
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$2,527.20 |
| Rate for Payer: Adventist Health Commercial |
$561.60
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,123.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,123.20
|
| Rate for Payer: Galaxy Health WC |
$2,386.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,684.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,527.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,872.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,069.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.60
|
| Rate for Payer: Multiplan Commercial |
$2,106.00
|
| Rate for Payer: Networks By Design Commercial |
$1,825.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,386.80
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$515.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$848.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| 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 |
$1,351.26
|
| 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 |
$1,417.90
|
| Rate for Payer: Cash Price |
$1,417.90
|
| Rate for Payer: Cash Price |
$1,417.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,062.40
|
| Rate for Payer: Cigna of CA HMO |
$1,649.92
|
| Rate for Payer: Cigna of CA PPO |
$1,907.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$2,191.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,546.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,320.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,719.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,933.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,675.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$848.09
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$2,191.30
|
| Rate for Payer: Prime Health Services Medicare |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,546.80
|
| 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 |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC INJ PROC FOR NEPH LOOP STENT GRAM
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 50431
|
| Hospital Charge Code |
909000167
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.60 |
| Max. Negotiated Rate |
$2,320.20 |
| Rate for Payer: Adventist Health Commercial |
$515.60
|
| Rate for Payer: Cash Price |
$1,417.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,062.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,031.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,031.20
|
| Rate for Payer: Galaxy Health WC |
$2,191.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,546.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,320.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,719.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$982.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,595.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.50
|
| Rate for Payer: Networks By Design Commercial |
$1,675.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,191.30
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$1,164.60 |
| Rate for Payer: Adventist Health Commercial |
$258.80
|
| Rate for Payer: Cash Price |
$711.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,035.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$517.60
|
| Rate for Payer: EPIC Health Plan Senior |
$517.60
|
| Rate for Payer: Galaxy Health WC |
$1,099.90
|
| Rate for Payer: Global Benefits Group Commercial |
$776.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,164.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$800.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.80
|
| Rate for Payer: Multiplan Commercial |
$970.50
|
| Rate for Payer: Networks By Design Commercial |
$841.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,099.90
|
|
