|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,124.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| 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 |
$1,745.55
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,103.20
|
| Rate for Payer: Cigna of CA HMO |
$2,482.56
|
| Rate for Payer: Cigna of CA PPO |
$2,870.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,715.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$3,297.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,327.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,491.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,583.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,463.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,973.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,521.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$3,297.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,327.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,939.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$3,879.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.80 |
| Max. Negotiated Rate |
$3,491.10 |
| Rate for Payer: Adventist Health Commercial |
$775.80
|
| Rate for Payer: Cash Price |
$1,745.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,715.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.60
|
| Rate for Payer: Galaxy Health WC |
$3,297.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,327.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,491.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,463.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.80
|
| Rate for Payer: Multiplan Commercial |
$2,909.25
|
| Rate for Payer: Networks By Design Commercial |
$2,521.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,297.15
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| 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 |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Adventist Health Commercial |
$140.40
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$491.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Senior |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$445.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,088.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$417.60 |
| Max. Negotiated Rate |
$1,879.20 |
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,670.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$835.20
|
| Rate for Payer: EPIC Health Plan Senior |
$835.20
|
| Rate for Payer: Galaxy Health WC |
$1,774.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,879.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,231.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
| Rate for Payer: Networks By Design Commercial |
$1,357.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.80
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$234.40 |
| Max. Negotiated Rate |
$3,306.29 |
| Rate for Payer: Adventist Health Commercial |
$234.40
|
| Rate for Payer: Adventist Health Commercial |
$417.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| 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 Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,306.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.59
|
| Rate for Payer: Blue Shield of California Commercial |
$738.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,315.44
|
| Rate for Payer: Blue Shield of California EPN |
$465.28
|
| Rate for Payer: Blue Shield of California EPN |
$828.94
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Center for Health Promotion Commercial |
$286.00
|
| Rate for Payer: Central Health Plan Commercial |
$937.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,670.40
|
| Rate for Payer: Cigna of CA HMO |
$750.08
|
| Rate for Payer: Cigna of CA HMO |
$1,336.32
|
| Rate for Payer: Cigna of CA PPO |
$1,545.12
|
| Rate for Payer: Cigna of CA PPO |
$867.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,461.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$996.20
|
| Rate for Payer: Galaxy Health WC |
$1,774.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,252.80
|
| Rate for Payer: Global Benefits Group Commercial |
$703.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,054.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,879.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,325.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$417.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,566.00
|
| Rate for Payer: Multiplan Commercial |
$879.00
|
| Rate for Payer: Networks By Design Commercial |
$761.80
|
| Rate for Payer: Networks By Design Commercial |
$1,357.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,774.80
|
| Rate for Payer: Prime Health Services Commercial |
$996.20
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,252.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,252.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| 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 Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.65
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.88
|
| Rate for Payer: Blue Shield of California Commercial |
$45.65
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Riverside University Health System MISP |
$28.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.47
|
| Rate for Payer: Blue Shield of California Commercial |
$873.38
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$691.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$642.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Riverside University Health System MISP |
$435.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Blue Shield of California Commercial |
$873.38
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$691.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$642.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.80
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$707.85
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
905356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$446.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$633.47
|
| Rate for Payer: Blue Shield of California Commercial |
$873.38
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$925.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$925.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$925.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$691.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$665.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$642.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$762.30
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$544.50
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: Riverside University Health System MISP |
$435.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$653.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$653.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$925.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Vantage Medical Group Senior |
$925.65
|
|
|
HC SD ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT L6689
|
| Hospital Charge Code |
915356689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Adventist Health Commercial |
$217.80
|
| Rate for Payer: Blue Shield of California Commercial |
$873.38
|
| Rate for Payer: Blue Shield of California EPN |
$548.86
|
| Rate for Payer: Cash Price |
$490.05
|
| Rate for Payer: Central Health Plan Commercial |
$871.20
|
| Rate for Payer: Cigna of CA HMO |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$762.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$435.60
|
| Rate for Payer: Galaxy Health WC |
$925.65
|
| Rate for Payer: Global Benefits Group Commercial |
$653.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$980.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$691.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$642.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.80
|
| Rate for Payer: Multiplan Commercial |
$816.75
|
| Rate for Payer: Networks By Design Commercial |
$707.85
|
| Rate for Payer: Prime Health Services Commercial |
$925.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$408.70
|
| Rate for Payer: United Healthcare All Other HMO |
$397.81
|
| Rate for Payer: United Healthcare HMO Rider |
$389.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$356.65
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,525.34 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,536.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7,632.63
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,525.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,043.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,615.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,901.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
915356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,903.40 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Adventist Health Commercial |
$1,903.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,632.63
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,043.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,615.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,903.40
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$6,186.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
OP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,525.34 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$3,901.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,234.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,137.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,536.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7,632.63
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,089.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,089.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,525.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,043.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,789.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,615.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,901.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,661.90
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$4,758.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,806.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,710.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,710.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,089.45
|
| Rate for Payer: Vantage Medical Group Senior |
$8,089.45
|
|
|
HC SD BLKHD HUM SECT INT LOCK ELB
|
Facility
|
IP
|
$9,517.00
|
|
|
Service Code
|
CPT L6300
|
| Hospital Charge Code |
905356300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,903.40 |
| Max. Negotiated Rate |
$8,565.30 |
| Rate for Payer: Adventist Health Commercial |
$1,903.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,632.63
|
| Rate for Payer: Blue Shield of California EPN |
$4,796.57
|
| Rate for Payer: Cash Price |
$4,282.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,613.60
|
| Rate for Payer: Cigna of CA HMO |
$6,661.90
|
| Rate for Payer: Cigna of CA PPO |
$6,661.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,661.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,806.80
|
| Rate for Payer: Galaxy Health WC |
$8,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,565.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,043.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,615.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,903.40
|
| Rate for Payer: Multiplan Commercial |
$7,137.75
|
| Rate for Payer: Networks By Design Commercial |
$6,186.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,089.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,571.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3,476.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,116.82
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,611.16 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,637.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,394.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,143.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,704.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,268.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
OP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,611.16 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$3,268.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,385.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,979.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,637.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,394.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,777.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,777.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,143.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,681.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,704.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,268.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,581.10
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$3,986.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: Riverside University Health System MISP |
$3,189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,777.05
|
| Rate for Payer: Vantage Medical Group Senior |
$6,777.05
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
905356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,394.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,704.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.60
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$5,182.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD ENDOSK INCL TISSUE SHAPING
|
Facility
|
IP
|
$7,973.00
|
|
|
Service Code
|
CPT L6550
|
| Hospital Charge Code |
915356550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,594.60 |
| Max. Negotiated Rate |
$7,175.70 |
| Rate for Payer: Adventist Health Commercial |
$1,594.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,394.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,018.39
|
| Rate for Payer: Cash Price |
$3,587.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,378.40
|
| Rate for Payer: Cigna of CA HMO |
$5,581.10
|
| Rate for Payer: Cigna of CA PPO |
$5,581.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,581.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,189.20
|
| Rate for Payer: Galaxy Health WC |
$6,777.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,175.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,704.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.60
|
| Rate for Payer: Multiplan Commercial |
$5,979.75
|
| Rate for Payer: Networks By Design Commercial |
$5,182.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,777.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,992.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,912.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2,849.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,611.16
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$745.86
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
905356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$745.86
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$604.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
|
|
HC SD/IT ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6684
|
| Hospital Charge Code |
915356684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.57 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.98
|
| Rate for Payer: Blue Shield of California Commercial |
$745.86
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$651.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$590.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
