|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$559.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$535.75
|
| Rate for Payer: Blue Shield of California Commercial |
$583.91
|
| Rate for Payer: Blue Shield of California EPN |
$367.48
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$921.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$506.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$690.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$445.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$535.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$782.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$782.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$782.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$334.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$644.70
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Riverside University Health System MISP |
$368.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$552.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.50
|
| Rate for Payer: United Healthcare All Other HMO |
$460.50
|
| Rate for Payer: United Healthcare HMO Rider |
$460.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$460.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$782.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$782.85
|
| Rate for Payer: Vantage Medical Group Senior |
$782.85
|
|
|
HC SEDATION GT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$921.00
|
|
| Hospital Charge Code |
907201214
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Central Health Plan Commercial |
$736.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$644.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$828.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$584.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.20
|
| Rate for Payer: Multiplan Commercial |
$690.75
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC SEDATION IV/IM OR INHALANT
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
907201040
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$511.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.28
|
| Rate for Payer: Blue Shield of California Commercial |
$669.50
|
| Rate for Payer: Blue Shield of California EPN |
$421.34
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$897.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Riverside University Health System MISP |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
IP
|
$1,056.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC SEDATION LT 5 YRS FIRST 15 MIN
|
Facility
|
OP
|
$1,056.00
|
|
| Hospital Charge Code |
907201213
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$580.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$511.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.28
|
| Rate for Payer: Blue Shield of California Commercial |
$669.50
|
| Rate for Payer: Blue Shield of California EPN |
$421.34
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Central Health Plan Commercial |
$844.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$897.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$897.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$897.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$950.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$739.20
|
| Rate for Payer: Multiplan Commercial |
$792.00
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Riverside University Health System MISP |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Other HMO |
$528.00
|
| Rate for Payer: United Healthcare HMO Rider |
$528.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$897.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Vantage Medical Group Senior |
$897.60
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC SED RATE WESTERGREN MANUAL
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 85651
|
| Hospital Charge Code |
900912022
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.88
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$93.24
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Blue Shield of California EPN |
$58.76
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4.70
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SED RATE WESTERGRN AUTOMATED
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 85652
|
| Hospital Charge Code |
900910025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.42
|
| Rate for Payer: Blue Shield of California Commercial |
$17.64
|
| Rate for Payer: Blue Shield of California Commercial |
$78.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.70
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$2.86
|
| Rate for Payer: Prime Health Services Medicare |
$2.86
|
| Rate for Payer: Riverside University Health System MISP |
$2.97
|
| Rate for Payer: Riverside University Health System MISP |
$2.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare All Other HMO |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare HMO Rider |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2.70
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
IP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
|
|
HC SEGURA-RETRIVAL BASKET
|
Facility
|
OP
|
$830.00
|
|
| Hospital Charge Code |
909001079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.00 |
| Max. Negotiated Rate |
$747.00 |
| Rate for Payer: Adventist Health Commercial |
$166.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$504.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$456.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$401.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$482.81
|
| Rate for Payer: Blue Shield of California Commercial |
$526.22
|
| Rate for Payer: Blue Shield of California EPN |
$331.17
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Central Health Plan Commercial |
$664.00
|
| Rate for Payer: Cigna of CA HMO |
$531.20
|
| Rate for Payer: Cigna of CA PPO |
$614.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$705.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$705.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$705.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$332.00
|
| Rate for Payer: Galaxy Health WC |
$705.50
|
| Rate for Payer: Global Benefits Group Commercial |
$498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$747.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$527.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$301.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$489.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$581.00
|
| Rate for Payer: Multiplan Commercial |
$622.50
|
| Rate for Payer: Networks By Design Commercial |
$539.50
|
| Rate for Payer: Prime Health Services Commercial |
$705.50
|
| Rate for Payer: Riverside University Health System MISP |
$332.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$498.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$415.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$705.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$705.50
|
| Rate for Payer: Vantage Medical Group Senior |
$705.50
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
|
|
HC SELECT CATH L/R PULMONARY ART
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
909081312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$302.08
|
| Rate for Payer: Cigna of CA PPO |
$349.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$424.80 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
|
|
HC SELECT CATH PULMON. ART SEGMENTAL
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 36015
|
| Hospital Charge Code |
909081313
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.00
|
| 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: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Central Health Plan Commercial |
$377.60
|
| Rate for Payer: Cigna of CA HMO |
$302.08
|
| Rate for Payer: Cigna of CA PPO |
$349.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$401.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$401.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$188.80
|
| Rate for Payer: Galaxy Health WC |
$401.20
|
| Rate for Payer: Global Benefits Group Commercial |
$283.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$424.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$195.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$330.40
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: Networks By Design Commercial |
$306.80
|
| Rate for Payer: Prime Health Services Commercial |
$401.20
|
| Rate for Payer: Riverside University Health System MISP |
$188.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$236.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$401.20
|
| Rate for Payer: Vantage Medical Group Senior |
$401.20
|
|
|
HC SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$510.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Cigna of CA HMO |
$796.80
|
| Rate for Payer: Cigna of CA PPO |
$921.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SELECT WND DBRD LT 20 SQ CM OT
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101300
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$498.00
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$734.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
|
|
HC SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$510.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Cigna of CA HMO |
$796.80
|
| Rate for Payer: Cigna of CA PPO |
$921.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$747.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SELECT WND DEBRD LT 20SQ CM PT
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
905101303
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$1,120.50 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Central Health Plan Commercial |
$996.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$871.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$498.00
|
| Rate for Payer: Galaxy Health WC |
$1,058.25
|
| Rate for Payer: Global Benefits Group Commercial |
$747.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,120.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$790.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$734.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Networks By Design Commercial |
$809.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,058.25
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
903501030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Riverside University Health System MISP |
$383.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
903501030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
901300072
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC SELECT WND DEBRIDE GT 20 SQ CM MCAL
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
900400060
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.67 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Riverside University Health System MISP |
$383.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
