|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
IP
|
$25.50
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
OP
|
$25.50
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.98
|
| Rate for Payer: Blue Shield of California Commercial |
$15.58
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: InnovAge PACE Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Riverside University Health System MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$15,177.60 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$9,275.20
|
| Rate for Payer: Cash Price |
$9,275.20
|
| Rate for Payer: Cash Price |
$9,275.20
|
| Rate for Payer: Cash Price |
$9,275.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,491.20
|
| Rate for Payer: Cigna of CA HMO |
$10,792.96
|
| Rate for Payer: Cigna of CA PPO |
$12,479.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$14,334.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,118.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,177.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,248.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$10,961.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,334.40
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,118.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,432.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,432.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,432.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,432.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,372.80 |
| Max. Negotiated Rate |
$15,177.60 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| Rate for Payer: Cash Price |
$9,275.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,491.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,745.60
|
| Rate for Payer: Galaxy Health WC |
$14,334.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,118.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,248.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,425.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.80
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
| Rate for Payer: Networks By Design Commercial |
$10,961.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,334.40
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,893.40 |
| Max. Negotiated Rate |
$31,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| Rate for Payer: Cash Price |
$18,956.85
|
| Rate for Payer: Central Health Plan Commercial |
$27,573.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,786.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,786.80
|
| Rate for Payer: Galaxy Health WC |
$29,296.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,680.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,020.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,989.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,131.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,335.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.40
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
| Rate for Payer: Networks By Design Commercial |
$22,403.55
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.95
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$31,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$18,956.85
|
| Rate for Payer: Cash Price |
$18,956.85
|
| Rate for Payer: Cash Price |
$18,956.85
|
| Rate for Payer: Cash Price |
$18,956.85
|
| Rate for Payer: Central Health Plan Commercial |
$27,573.60
|
| Rate for Payer: Cigna of CA HMO |
$22,058.88
|
| Rate for Payer: Cigna of CA PPO |
$25,505.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$29,296.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,680.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,020.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,989.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$22,403.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.95
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,680.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17,233.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,233.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
IP
|
$23,129.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,625.80 |
| Max. Negotiated Rate |
$20,816.10 |
| Rate for Payer: Adventist Health Commercial |
$4,625.80
|
| Rate for Payer: Cash Price |
$12,720.95
|
| Rate for Payer: Central Health Plan Commercial |
$18,503.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,251.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,251.60
|
| Rate for Payer: Galaxy Health WC |
$19,659.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,877.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,816.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,427.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,812.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,316.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.80
|
| Rate for Payer: Multiplan Commercial |
$17,346.75
|
| Rate for Payer: Networks By Design Commercial |
$15,033.85
|
| Rate for Payer: Prime Health Services Commercial |
$19,659.65
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
OP
|
$23,129.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$20,816.10 |
| Rate for Payer: Adventist Health Commercial |
$4,625.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$12,720.95
|
| Rate for Payer: Cash Price |
$12,720.95
|
| Rate for Payer: Cash Price |
$12,720.95
|
| Rate for Payer: Cash Price |
$12,720.95
|
| Rate for Payer: Central Health Plan Commercial |
$18,503.20
|
| Rate for Payer: Cigna of CA HMO |
$14,802.56
|
| Rate for Payer: Cigna of CA PPO |
$17,115.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$19,659.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,877.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,816.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,427.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$17,346.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$15,033.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$19,659.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,877.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,564.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,564.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,564.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,564.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,106.40
|
| Rate for Payer: Galaxy Health WC |
$12,976.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,739.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,816.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,449.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: Cigna of CA HMO |
$9,770.24
|
| Rate for Payer: Cigna of CA PPO |
$11,296.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$12,976.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,739.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,106.40
|
| Rate for Payer: Galaxy Health WC |
$12,976.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,739.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,816.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,449.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$6,259.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Cash Price |
$8,396.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: Cigna of CA HMO |
$9,770.24
|
| Rate for Payer: Cigna of CA PPO |
$11,296.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$12,976.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,739.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,182.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
IP
|
$19,476.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,895.20 |
| Max. Negotiated Rate |
$17,528.40 |
| Rate for Payer: Adventist Health Commercial |
$3,895.20
|
| Rate for Payer: Cash Price |
$10,711.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,790.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,790.40
|
| Rate for Payer: Galaxy Health WC |
$16,554.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,685.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,528.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,990.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,420.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,055.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,895.20
|
| Rate for Payer: Multiplan Commercial |
$14,607.00
|
| Rate for Payer: Networks By Design Commercial |
$12,659.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,554.60
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
OP
|
$19,476.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$17,528.40 |
| Rate for Payer: Adventist Health Commercial |
$3,895.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$10,711.80
|
| Rate for Payer: Cash Price |
$10,711.80
|
| Rate for Payer: Cash Price |
$10,711.80
|
| Rate for Payer: Cash Price |
$10,711.80
|
| Rate for Payer: Central Health Plan Commercial |
$15,580.80
|
| Rate for Payer: Cigna of CA HMO |
$12,464.64
|
| Rate for Payer: Cigna of CA PPO |
$14,412.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$16,554.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,685.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,528.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,990.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,895.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$14,607.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$12,659.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$16,554.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,685.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,738.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| 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 |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Cigna of CA HMO |
$11,556.48
|
| Rate for Payer: Cigna of CA PPO |
$13,362.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,044.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,834.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,028.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,028.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,028.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,028.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,611.40 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,222.80
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,044.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,879.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,177.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,611.40 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,222.80
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,044.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,879.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,177.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$7,403.37
|
| 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 |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Cash Price |
$9,931.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Cigna of CA HMO |
$11,556.48
|
| Rate for Payer: Cigna of CA PPO |
$13,362.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,044.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,834.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,834.20
|
| 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 |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$13,365.90 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Cash Price |
$8,168.05
|
| Rate for Payer: Cash Price |
$8,168.05
|
| Rate for Payer: Cash Price |
$8,168.05
|
| Rate for Payer: Cash Price |
$8,168.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,880.80
|
| Rate for Payer: Cigna of CA HMO |
$9,504.64
|
| Rate for Payer: Cigna of CA PPO |
$10,989.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$12,623.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,910.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,365.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,970.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$9,653.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Commercial |
$12,623.35
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,910.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,425.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,970.20 |
| Max. Negotiated Rate |
$13,365.90 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Cash Price |
$8,168.05
|
| Rate for Payer: Central Health Plan Commercial |
$11,880.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,940.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,940.40
|
| Rate for Payer: Galaxy Health WC |
$12,623.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,910.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,365.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,658.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,192.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,970.20
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Networks By Design Commercial |
$9,653.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,623.35
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$14,419.80 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Central Health Plan Commercial |
$12,817.60
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,419.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,204.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,011.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,011.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,011.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,204.40 |
| Max. Negotiated Rate |
$14,419.80 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Cash Price |
$8,812.10
|
| Rate for Payer: Central Health Plan Commercial |
$12,817.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,408.80
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,419.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,686.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,104.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,917.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,204.40
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$20,200.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,040.00 |
| Max. Negotiated Rate |
$18,180.00 |
| Rate for Payer: Adventist Health Commercial |
$4,040.00
|
| Rate for Payer: Cash Price |
$11,110.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,080.00
|
| Rate for Payer: Galaxy Health WC |
$17,170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,473.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,696.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,503.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,040.00
|
| Rate for Payer: Multiplan Commercial |
$15,150.00
|
| Rate for Payer: Networks By Design Commercial |
$13,130.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,170.00
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$20,200.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$18,180.00 |
| Rate for Payer: Adventist Health Commercial |
$4,040.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$11,110.00
|
| Rate for Payer: Cash Price |
$11,110.00
|
| Rate for Payer: Cash Price |
$11,110.00
|
| Rate for Payer: Cash Price |
$11,110.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,160.00
|
| Rate for Payer: Cigna of CA HMO |
$12,928.00
|
| Rate for Payer: Cigna of CA PPO |
$14,948.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$17,170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,473.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$15,150.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$13,130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$17,170.00
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,100.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,698.00 |
| Max. Negotiated Rate |
$12,141.00 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Cash Price |
$7,419.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,792.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,396.00
|
| Rate for Payer: Galaxy Health WC |
$11,466.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,094.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,997.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,139.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,350.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,698.00
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
| Rate for Payer: Networks By Design Commercial |
$8,768.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,466.50
|
|
