|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$370.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,019.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,389.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: Cigna of CA HMO |
$1,185.92
|
| Rate for Payer: Cigna of CA PPO |
$1,371.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,575.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,575.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,297.10
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
| Rate for Payer: Riverside University Health System MISP |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,111.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.50
|
| Rate for Payer: United Healthcare All Other HMO |
$926.50
|
| Rate for Payer: United Healthcare HMO Rider |
$926.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,575.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,575.05
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Adventist Health Commercial |
$370.60
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Adventist Health Commercial |
$370.60
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$759.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,019.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,389.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Cash Price |
$833.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,482.40
|
| Rate for Payer: Cigna of CA HMO |
$1,185.92
|
| Rate for Payer: Cigna of CA PPO |
$1,371.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,575.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,575.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.20
|
| Rate for Payer: EPIC Health Plan Senior |
$741.20
|
| Rate for Payer: Galaxy Health WC |
$1,575.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,667.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,297.10
|
| Rate for Payer: Multiplan Commercial |
$1,389.75
|
| Rate for Payer: Networks By Design Commercial |
$1,204.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.05
|
| Rate for Payer: Riverside University Health System MISP |
$741.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,111.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,111.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,575.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,575.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,575.05
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$1,430.10 |
| Rate for Payer: Adventist Health Commercial |
$317.80
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,271.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,112.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.60
|
| Rate for Payer: EPIC Health Plan Senior |
$635.60
|
| Rate for Payer: Galaxy Health WC |
$1,350.65
|
| Rate for Payer: Global Benefits Group Commercial |
$953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,430.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,009.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$937.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.80
|
| Rate for Payer: Multiplan Commercial |
$1,191.75
|
| Rate for Payer: Networks By Design Commercial |
$1,032.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,350.65
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$317.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,350.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$873.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,271.20
|
| Rate for Payer: Cigna of CA HMO |
$1,016.96
|
| Rate for Payer: Cigna of CA PPO |
$1,175.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,350.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,350.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,350.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,112.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.60
|
| Rate for Payer: EPIC Health Plan Senior |
$635.60
|
| Rate for Payer: Galaxy Health WC |
$1,350.65
|
| Rate for Payer: Global Benefits Group Commercial |
$953.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,430.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,009.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$937.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,112.30
|
| Rate for Payer: Multiplan Commercial |
$1,191.75
|
| Rate for Payer: Networks By Design Commercial |
$1,032.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,350.65
|
| Rate for Payer: Riverside University Health System MISP |
$635.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$953.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$794.50
|
| Rate for Payer: United Healthcare All Other HMO |
$794.50
|
| Rate for Payer: United Healthcare HMO Rider |
$794.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,350.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,350.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,350.65
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$2,648.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$529.60 |
| Max. Negotiated Rate |
$2,383.20 |
| Rate for Payer: Adventist Health Commercial |
$529.60
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,118.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,059.20
|
| Rate for Payer: Galaxy Health WC |
$2,250.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,588.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,383.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,681.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,562.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.60
|
| Rate for Payer: Multiplan Commercial |
$1,986.00
|
| Rate for Payer: Networks By Design Commercial |
$1,721.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,250.80
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$2,648.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$529.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,250.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,456.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,986.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Cash Price |
$1,191.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,118.40
|
| Rate for Payer: Cigna of CA HMO |
$1,694.72
|
| Rate for Payer: Cigna of CA PPO |
$1,959.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,250.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,250.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,250.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,059.20
|
| Rate for Payer: Galaxy Health WC |
$2,250.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,588.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,383.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,681.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,562.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,853.60
|
| Rate for Payer: Multiplan Commercial |
$1,986.00
|
| Rate for Payer: Networks By Design Commercial |
$1,721.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,250.80
|
| Rate for Payer: Riverside University Health System MISP |
$1,059.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,324.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,324.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,324.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,250.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,250.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,250.80
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$7,687.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,149.60
|
| Rate for Payer: Cigna of CA HMO |
$4,919.68
|
| Rate for Payer: Cigna of CA PPO |
$5,688.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,380.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,918.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,881.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,765.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,612.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,843.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,843.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,843.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,843.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$7,687.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,537.40 |
| Max. Negotiated Rate |
$6,918.30 |
| Rate for Payer: Adventist Health Commercial |
$1,537.40
|
| Rate for Payer: Cash Price |
$3,459.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,149.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,380.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,074.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,074.80
|
| Rate for Payer: Galaxy Health WC |
$6,533.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,612.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,918.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,881.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,535.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.40
|
| Rate for Payer: Multiplan Commercial |
$5,765.25
|
| Rate for Payer: Networks By Design Commercial |
$4,996.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,533.95
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$9,689.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,937.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,751.20
|
| Rate for Payer: Cigna of CA HMO |
$6,200.96
|
| Rate for Payer: Cigna of CA PPO |
$7,169.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,782.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$8,235.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,813.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,720.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,152.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,266.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,297.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$8,235.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,813.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,844.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,844.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,844.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,844.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$9,689.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$3,972.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,346.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,751.20
|
| Rate for Payer: Cigna of CA HMO |
$6,200.96
|
| Rate for Payer: Cigna of CA PPO |
$7,169.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,782.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$8,235.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,813.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,720.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,152.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,266.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,297.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$8,235.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,813.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,813.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$9,689.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,937.80 |
| Max. Negotiated Rate |
$8,720.10 |
| Rate for Payer: Adventist Health Commercial |
$1,937.80
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,751.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,782.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,875.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,875.60
|
| Rate for Payer: Galaxy Health WC |
$8,235.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,813.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,720.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,152.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,716.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.80
|
| Rate for Payer: Multiplan Commercial |
$7,266.75
|
| Rate for Payer: Networks By Design Commercial |
$6,297.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,235.65
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$9,689.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,937.80 |
| Max. Negotiated Rate |
$8,720.10 |
| Rate for Payer: Adventist Health Commercial |
$1,937.80
|
| Rate for Payer: Cash Price |
$4,360.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,751.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,782.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,875.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,875.60
|
| Rate for Payer: Galaxy Health WC |
$8,235.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,813.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,720.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,152.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,716.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.80
|
| Rate for Payer: Multiplan Commercial |
$7,266.75
|
| Rate for Payer: Networks By Design Commercial |
$6,297.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,235.65
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,760.40 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,369.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,760.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,242.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,154.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.20
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,075.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,467.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.80
|
| Rate for Payer: Cigna of CA HMO |
$1,251.84
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,662.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,662.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,369.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,760.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,242.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,154.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,369.20
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Riverside University Health System MISP |
$782.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$978.00
|
| Rate for Payer: United Healthcare All Other HMO |
$978.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$978.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,662.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,662.60
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$17,186.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,437.20 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,874.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,874.40
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,139.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$17,186.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$15,467.40 |
| Rate for Payer: Adventist Health Commercial |
$3,437.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,393.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Cash Price |
$7,733.70
|
| Rate for Payer: Central Health Plan Commercial |
$13,748.80
|
| Rate for Payer: Cigna of CA HMO |
$10,999.04
|
| Rate for Payer: Cigna of CA PPO |
$12,717.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,833.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,393.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,249.67
|
| Rate for Payer: EPIC Health Plan Senior |
$4,833.11
|
| Rate for Payer: Galaxy Health WC |
$14,608.10
|
| Rate for Payer: Global Benefits Group Commercial |
$10,311.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,467.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,913.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,723.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,437.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,887.61
|
| Rate for Payer: Multiplan Commercial |
$12,889.50
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$11,170.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Commercial |
$14,608.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,657.36
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,833.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,311.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,593.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,393.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4,393.74
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$11,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,248.00
|
| Rate for Payer: Galaxy Health WC |
$11,152.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,808.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,740.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,624.00
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
| Rate for Payer: Networks By Design Commercial |
$8,528.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,152.00
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$11,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,496.00
|
| Rate for Payer: Cigna of CA HMO |
$8,396.80
|
| Rate for Payer: Cigna of CA PPO |
$9,708.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Galaxy Health WC |
$11,152.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,808.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,950.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$8,528.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,152.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,881.29
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,065.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,560.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$11,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,496.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,248.00
|
| Rate for Payer: Galaxy Health WC |
$11,152.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,808.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,740.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,624.00
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
| Rate for Payer: Networks By Design Commercial |
$8,528.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,152.00
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$11,808.00 |
| Rate for Payer: Adventist Health Commercial |
$5,379.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,500.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,496.00
|
| Rate for Payer: Cigna of CA HMO |
$8,396.80
|
| Rate for Payer: Cigna of CA PPO |
$9,708.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Galaxy Health WC |
$11,152.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,872.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,808.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,331.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,950.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$8,528.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,152.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,881.29
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,065.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,872.00
|
| 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 |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$2,485.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$2,236.50 |
| Rate for Payer: Adventist Health Commercial |
$497.00
|
| Rate for Payer: Cash Price |
$1,118.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$994.00
|
| Rate for Payer: EPIC Health Plan Senior |
$994.00
|
| Rate for Payer: Galaxy Health WC |
$2,112.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,236.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,466.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$1,863.75
|
| Rate for Payer: Networks By Design Commercial |
$1,615.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,112.25
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$2,485.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$497.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,118.25
|
| Rate for Payer: Cash Price |
$1,118.25
|
| Rate for Payer: Cash Price |
$1,118.25
|
| Rate for Payer: Cash Price |
$1,118.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,988.00
|
| Rate for Payer: Cigna of CA HMO |
$1,590.40
|
| Rate for Payer: Cigna of CA PPO |
$1,838.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,112.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,491.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,236.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,863.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,615.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,112.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,491.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,242.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,242.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,242.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,242.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$3,632.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$296.38 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,489.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,249.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,905.60
|
| Rate for Payer: Cigna of CA HMO |
$2,324.48
|
| Rate for Payer: Cigna of CA PPO |
$2,687.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,542.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$3,087.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,179.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,268.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,306.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$2,724.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$2,360.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,087.20
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,179.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,179.20
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
