|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: EPIC Health Plan Senior |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$1,118.97 |
| Rate for Payer: Adventist Health Commercial |
$218.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$302.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.46
|
| Rate for Payer: Blue Shield of California Commercial |
$688.59
|
| Rate for Payer: Blue Shield of California EPN |
$433.92
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$765.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$694.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$1,118.97 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,118.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$478.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$665.85
|
| Rate for Payer: Blue Shield of California Commercial |
$582.12
|
| Rate for Payer: Blue Shield of California EPN |
$366.83
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$586.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Adventist Health Commercial |
$184.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$646.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$586.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.63
|
| Rate for Payer: Blue Shield of California Commercial |
$87.72
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Riverside University Health System MISP |
$43.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Blue Shield of California Commercial |
$87.72
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.63
|
| Rate for Payer: Blue Shield of California Commercial |
$87.72
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Riverside University Health System MISP |
$43.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Blue Shield of California Commercial |
$87.72
|
| Rate for Payer: Blue Shield of California EPN |
$55.13
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Central Health Plan Commercial |
$87.50
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.88
|
| Rate for Payer: Multiplan Commercial |
$82.03
|
| Rate for Payer: Networks By Design Commercial |
$71.10
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.84 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.18
|
| Rate for Payer: Blue Shield of California Commercial |
$158.80
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Riverside University Health System MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Blue Shield of California Commercial |
$158.80
|
| Rate for Payer: Blue Shield of California EPN |
$99.79
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$125.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.31
|
| Rate for Payer: United Healthcare All Other HMO |
$72.33
|
| Rate for Payer: United Healthcare HMO Rider |
$70.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.84
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$47,412.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,482.40 |
| Max. Negotiated Rate |
$42,670.80 |
| Rate for Payer: Adventist Health Commercial |
$9,482.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Central Health Plan Commercial |
$37,929.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,188.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,964.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18,964.80
|
| Rate for Payer: Galaxy Health WC |
$40,300.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28,447.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,670.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,106.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,973.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,482.40
|
| Rate for Payer: Multiplan Commercial |
$35,559.00
|
| Rate for Payer: Networks By Design Commercial |
$30,817.80
|
| Rate for Payer: Prime Health Services Commercial |
$40,300.20
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$47,412.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.67 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,482.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,320.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,542.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Cash Price |
$21,335.40
|
| Rate for Payer: Central Health Plan Commercial |
$37,929.60
|
| Rate for Payer: Cigna of CA HMO |
$30,343.68
|
| Rate for Payer: Cigna of CA PPO |
$35,084.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,188.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,078.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8,052.33
|
| Rate for Payer: Galaxy Health WC |
$40,300.20
|
| Rate for Payer: Global Benefits Group Commercial |
$28,447.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,670.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,005.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$429.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,106.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,482.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$35,559.00
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$30,817.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Preferred Health Network WC |
$11,778.14
|
| Rate for Payer: Prime Health Services Commercial |
$40,300.20
|
| Rate for Payer: Prime Health Services Medicare |
$7,759.52
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Riverside University Health System MISP |
$8,052.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,447.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,706.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,320.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,056.20 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| 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 |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,494.40
|
| Rate for Payer: Cigna of CA HMO |
$3,595.52
|
| Rate for Payer: Cigna of CA PPO |
$4,157.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,932.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,056.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,567.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$4,213.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,809.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,809.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,809.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,123.60 |
| Max. Negotiated Rate |
$5,056.20 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,494.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,932.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,247.20
|
| Rate for Payer: Galaxy Health WC |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,056.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,567.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,314.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.60
|
| Rate for Payer: Multiplan Commercial |
$4,213.50
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.05
|
| Rate for Payer: Blue Shield of California Commercial |
$182.05
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Riverside University Health System MISP |
$90.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC REV KNUCKLE BENDER W/OUTRIGGER
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203944
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Blue Shield of California Commercial |
$182.05
|
| Rate for Payer: Blue Shield of California EPN |
$114.41
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$38,787.20
|
| Rate for Payer: Cigna of CA HMO |
$31,029.76
|
| Rate for Payer: Cigna of CA PPO |
$35,878.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,635.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,787.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,696.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$36,363.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,696.80 |
| Max. Negotiated Rate |
$43,635.60 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$38,787.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,393.60
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$43,635.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,787.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,605.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,696.80
|
| Rate for Payer: Multiplan Commercial |
$36,363.00
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV ATHER TIB ANGIO
|
Facility
|
IP
|
$58,944.00
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
906819793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,788.80 |
| Max. Negotiated Rate |
$53,049.60 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Central Health Plan Commercial |
$47,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,577.60
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,049.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,776.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,788.80
|
| Rate for Payer: Multiplan Commercial |
$44,208.00
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV ATHER TIB ANGIO
|
Facility
|
OP
|
$58,944.00
|
|
|
Service Code
|
CPT C9774
|
| Hospital Charge Code |
906819793
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$53,049.60 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Central Health Plan Commercial |
$47,155.20
|
| Rate for Payer: Cigna of CA HMO |
$37,724.16
|
| Rate for Payer: Cigna of CA PPO |
$43,618.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,049.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$44,208.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV STNT TIB ANGIO
|
Facility
|
OP
|
$58,944.00
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
906819792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$53,049.60 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$36,352.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Central Health Plan Commercial |
$47,155.20
|
| Rate for Payer: Cigna of CA HMO |
$37,724.16
|
| Rate for Payer: Cigna of CA PPO |
$43,618.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,049.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$44,208.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Preferred Health Network WC |
$37,094.82
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,472.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV STNT TIB ANGIO
|
Facility
|
IP
|
$58,944.00
|
|
|
Service Code
|
CPT C9773
|
| Hospital Charge Code |
906819792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,788.80 |
| Max. Negotiated Rate |
$53,049.60 |
| Rate for Payer: Adventist Health Commercial |
$11,788.80
|
| Rate for Payer: Cash Price |
$26,524.80
|
| Rate for Payer: Central Health Plan Commercial |
$47,155.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23,577.60
|
| Rate for Payer: Galaxy Health WC |
$50,102.40
|
| Rate for Payer: Global Benefits Group Commercial |
$35,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,049.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37,429.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34,776.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,788.80
|
| Rate for Payer: Multiplan Commercial |
$44,208.00
|
| Rate for Payer: Networks By Design Commercial |
$38,313.60
|
| Rate for Payer: Prime Health Services Commercial |
$50,102.40
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV TIB ANGIO
|
Facility
|
IP
|
$37,119.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
906819791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,423.80 |
| Max. Negotiated Rate |
$33,407.10 |
| Rate for Payer: Adventist Health Commercial |
$7,423.80
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,695.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,983.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,847.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,847.60
|
| Rate for Payer: Galaxy Health WC |
$31,551.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,271.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,407.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,570.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,900.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,423.80
|
| Rate for Payer: Multiplan Commercial |
$27,839.25
|
| Rate for Payer: Networks By Design Commercial |
$24,127.35
|
| Rate for Payer: Prime Health Services Commercial |
$31,551.15
|
|
|
HC REVSCLRZTN EV OPEN OR PERC IV TIB ANGIO
|
Facility
|
OP
|
$37,119.00
|
|
|
Service Code
|
CPT C9772
|
| Hospital Charge Code |
906819791
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,914.40 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,423.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| 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 |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Cash Price |
$16,703.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,695.20
|
| Rate for Payer: Cigna of CA HMO |
$23,756.16
|
| Rate for Payer: Cigna of CA PPO |
$27,468.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,983.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$31,551.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,271.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,407.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,570.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,423.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,839.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$24,127.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$31,551.15
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,271.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,559.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$8,484.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$785.08 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,696.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| 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 |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,817.80
|
| Rate for Payer: Cash Price |
$3,817.80
|
| Rate for Payer: Cash Price |
$3,817.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,787.20
|
| Rate for Payer: Cigna of CA HMO |
$5,429.76
|
| Rate for Payer: Cigna of CA PPO |
$6,278.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,938.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$7,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,090.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,635.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$785.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,387.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$867.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,696.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$6,363.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$5,514.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$7,211.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
