|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$649.20 |
| Max. Negotiated Rate |
$2,921.40 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,298.40
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,165.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,009.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
|
|
HC LAY CLOS OF WND 7.6-12.5 CM
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
900501031
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,596.80
|
| Rate for Payer: Cigna of CA HMO |
$2,077.44
|
| Rate for Payer: Cigna of CA PPO |
$2,402.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,759.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,947.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,921.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,165.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$649.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,109.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,759.10
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,947.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,623.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,623.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,623.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
|
IP
|
$4,744.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$948.80 |
| Max. Negotiated Rate |
$4,269.60 |
| Rate for Payer: Adventist Health Commercial |
$948.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,795.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,897.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,897.60
|
| Rate for Payer: Galaxy Health WC |
$4,032.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,846.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,269.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,164.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,807.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,936.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$948.80
|
| Rate for Payer: Multiplan Commercial |
$3,558.00
|
| Rate for Payer: Networks By Design Commercial |
$3,083.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,032.40
|
|
|
HC LAY CLOS OF WND GT 30.0 CM
|
Facility
|
OP
|
$4,744.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
900501643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$948.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,795.20
|
| Rate for Payer: Cigna of CA HMO |
$3,036.16
|
| Rate for Payer: Cigna of CA PPO |
$3,510.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$4,032.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,846.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,269.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,164.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$948.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,558.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$3,083.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$4,032.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,846.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,372.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,372.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,372.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,372.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$578.00
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.00
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,788.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$578.00
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.00
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,788.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,184.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: Cigna of CA HMO |
$1,849.60
|
| Rate for Payer: Cigna of CA PPO |
$2,138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,734.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,734.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$578.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: Cigna of CA HMO |
$1,849.60
|
| Rate for Payer: Cigna of CA PPO |
$2,138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,734.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,445.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,445.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,445.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
OP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$578.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: Cigna of CA HMO |
$1,849.60
|
| Rate for Payer: Cigna of CA PPO |
$2,138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$455.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,734.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND LT 2.5 CM FACE
|
Facility
|
IP
|
$2,890.00
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
900501035
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$578.00
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,312.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.00
|
| Rate for Payer: Galaxy Health WC |
$2,456.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,734.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,601.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,927.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,788.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Multiplan Commercial |
$2,167.50
|
| Rate for Payer: Networks By Design Commercial |
$1,878.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,456.50
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
OP
|
$1,930.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$791.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WND LT 2.5 CM SCALP
|
Facility
|
IP
|
$1,930.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
900501029
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.43 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,996.16
|
| Rate for Payer: Cigna of CA PPO |
$2,308.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$777.77
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
| Rate for Payer: Prime Health Services Medicare |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,871.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,559.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,559.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,559.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,559.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC LAY CLOS OF WNDS 12.6- 20.0 CM
|
Facility
|
IP
|
$3,119.00
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
900501416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$623.80 |
| Max. Negotiated Rate |
$2,807.10 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,247.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,247.60
|
| Rate for Payer: Galaxy Health WC |
$2,651.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,871.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,807.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,080.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,930.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.80
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: Networks By Design Commercial |
$2,027.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,651.15
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: Adventist Health Commercial |
$763.00
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,526.00
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,453.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$763.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: Cigna of CA HMO |
$2,441.60
|
| Rate for Payer: Cigna of CA PPO |
$2,823.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,289.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,907.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,907.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,907.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,907.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
OP
|
$3,815.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,564.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: Cigna of CA HMO |
$2,441.60
|
| Rate for Payer: Cigna of CA PPO |
$2,823.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,289.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,289.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 12.6-20.0 CM
|
Facility
|
IP
|
$3,815.00
|
|
|
Service Code
|
CPT 12055
|
| Hospital Charge Code |
900501039
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$763.00 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: Adventist Health Commercial |
$763.00
|
| Rate for Payer: Cash Price |
$1,716.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,052.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,526.00
|
| Rate for Payer: Galaxy Health WC |
$3,242.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,289.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,433.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,544.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,453.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$763.00
|
| Rate for Payer: Multiplan Commercial |
$2,861.25
|
| Rate for Payer: Networks By Design Commercial |
$2,479.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,242.75
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
IP
|
$4,004.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$800.80 |
| Max. Negotiated Rate |
$3,603.60 |
| Rate for Payer: Adventist Health Commercial |
$800.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,601.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,601.60
|
| Rate for Payer: Galaxy Health WC |
$3,403.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,402.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,603.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,670.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,478.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.80
|
| Rate for Payer: Multiplan Commercial |
$3,003.00
|
| Rate for Payer: Networks By Design Commercial |
$2,602.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,403.40
|
|
|
HC LAY CLOS OF WNDS 20.1-30.0 CM
|
Facility
|
OP
|
$4,004.00
|
|
|
Service Code
|
CPT 12056
|
| Hospital Charge Code |
900501525
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$800.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,203.20
|
| Rate for Payer: Cigna of CA HMO |
$2,562.56
|
| Rate for Payer: Cigna of CA PPO |
$2,962.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$3,403.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,402.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,603.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,670.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$3,003.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,602.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,403.40
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,402.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,002.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,002.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,002.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,002.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$658.80 |
| Max. Negotiated Rate |
$2,964.60 |
| Rate for Payer: Adventist Health Commercial |
$658.80
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,317.60
|
| Rate for Payer: Galaxy Health WC |
$2,799.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,964.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,038.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.80
|
| Rate for Payer: Multiplan Commercial |
$2,470.50
|
| Rate for Payer: Networks By Design Commercial |
$2,141.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,799.90
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
OP
|
$3,294.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$2,964.60 |
| Rate for Payer: Adventist Health Commercial |
$658.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,635.20
|
| Rate for Payer: Cigna of CA HMO |
$2,108.16
|
| Rate for Payer: Cigna of CA PPO |
$2,437.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$2,799.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,964.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$2,470.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,141.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,799.90
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,976.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,647.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,647.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,647.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,647.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC LAY CLOS OF WNDS 2.6-5.0 CM
|
Facility
|
IP
|
$3,294.00
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
900501036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$658.80 |
| Max. Negotiated Rate |
$2,964.60 |
| Rate for Payer: Adventist Health Commercial |
$658.80
|
| Rate for Payer: Cash Price |
$1,482.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,635.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,317.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,317.60
|
| Rate for Payer: Galaxy Health WC |
$2,799.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,976.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,964.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,038.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.80
|
| Rate for Payer: Multiplan Commercial |
$2,470.50
|
| Rate for Payer: Networks By Design Commercial |
$2,141.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,799.90
|
|
