|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
IP
|
$2,399.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$479.80 |
| Max. Negotiated Rate |
$2,159.10 |
| Rate for Payer: Adventist Health Commercial |
$479.80
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,919.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,679.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$959.60
|
| Rate for Payer: EPIC Health Plan Senior |
$959.60
|
| Rate for Payer: Galaxy Health WC |
$2,039.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,439.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,159.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,523.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,415.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.80
|
| Rate for Payer: Multiplan Commercial |
$1,799.25
|
| Rate for Payer: Networks By Design Commercial |
$1,559.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,039.15
|
|
|
HC SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$2,399.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$479.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,919.20
|
| Rate for Payer: Cigna of CA HMO |
$1,535.36
|
| Rate for Payer: Cigna of CA PPO |
$1,775.26
|
| 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 |
$1,679.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,039.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,439.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,159.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,523.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,799.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,559.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,039.15
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,439.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,199.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,199.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,199.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,199.50
|
| 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 SIMP REP SUP WND 2.6 - 5.0 CM
|
Facility
|
OP
|
$2,399.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
900501026
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$204.16 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$983.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$406.86
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Cash Price |
$1,079.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,919.20
|
| Rate for Payer: Cigna of CA HMO |
$1,535.36
|
| Rate for Payer: Cigna of CA PPO |
$1,775.26
|
| 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 |
$1,679.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,039.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,439.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,159.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,523.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,799.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,559.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,039.15
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,439.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,439.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,371.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.22 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,488.00
|
| Rate for Payer: Cigna of CA PPO |
$1,720.50
|
| 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 |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$179.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,162.50
|
| 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: 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 SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,371.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,371.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
|
|
HC SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$197.98 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$953.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.98
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,488.00
|
| Rate for Payer: Cigna of CA PPO |
$1,720.50
|
| 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 |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIMP REP SUP WND 2.6-7.5 CM
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
900501021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.98 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,488.00
|
| Rate for Payer: Cigna of CA PPO |
$1,720.50
|
| 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 |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,511.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,162.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,162.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,162.50
|
| 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 SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,795.20
|
| Rate for Payer: Cigna of CA PPO |
$2,075.70
|
| 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 |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,402.50
|
| 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 SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
|
|
HC SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$176.13 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,150.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.64
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,795.20
|
| Rate for Payer: Cigna of CA PPO |
$2,075.70
|
| 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 |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,683.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIMP REP SUP WND 5.1 - 7.5 CM
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
900501027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,963.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,781.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,654.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$500.80 |
| Max. Negotiated Rate |
$2,253.60 |
| Rate for Payer: Adventist Health Commercial |
$500.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.60
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,253.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,590.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,477.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.80
|
| Rate for Payer: Multiplan Commercial |
$1,878.00
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
|
|
HC SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$500.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Cigna of CA HMO |
$1,602.56
|
| Rate for Payer: Cigna of CA PPO |
$1,852.96
|
| 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 |
$1,752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,253.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,590.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,878.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,252.00
|
| 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 SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,026.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$468.28
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Cigna of CA HMO |
$1,602.56
|
| Rate for Payer: Cigna of CA PPO |
$1,852.96
|
| 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 |
$1,752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,253.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,590.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,878.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,502.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,502.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 SIMP REP SUP WND 7.6 - 12.5 CM
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
900501022
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$500.80 |
| Max. Negotiated Rate |
$2,253.60 |
| Rate for Payer: Adventist Health Commercial |
$500.80
|
| Rate for Payer: Cash Price |
$1,126.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.60
|
| Rate for Payer: Galaxy Health WC |
$2,128.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,502.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,253.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,590.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,477.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.80
|
| Rate for Payer: Multiplan Commercial |
$1,878.00
|
| Rate for Payer: Networks By Design Commercial |
$1,627.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,128.40
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,774.70 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,466.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,774.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,818.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.60
|
| Rate for Payer: Multiplan Commercial |
$2,312.25
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.03
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$614.61
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,973.12
|
| Rate for Payer: Cigna of CA PPO |
$2,281.42
|
| 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 |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,774.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,312.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,849.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,849.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: 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 SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,774.70 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,466.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,774.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,818.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.60
|
| Rate for Payer: Multiplan Commercial |
$2,312.25
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC SIMP REP SUP WND 7.6-12.5CM FACE
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
900501028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,466.40
|
| Rate for Payer: Cigna of CA HMO |
$1,973.12
|
| Rate for Payer: Cigna of CA PPO |
$2,281.42
|
| 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 |
$2,158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,774.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,957.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$616.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$2,312.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,849.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,541.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,541.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,541.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,541.50
|
| 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 SIMP REP SUP WND GT 30.0CM
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$997.60 |
| Max. Negotiated Rate |
$4,489.20 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,995.20
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,167.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,942.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
|
|
HC SIMP REP SUP WND GT 30.0CM
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 12018
|
| Hospital Charge Code |
900501732
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$997.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Cash Price |
$2,244.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,990.40
|
| Rate for Payer: Cigna of CA HMO |
$3,192.32
|
| Rate for Payer: Cigna of CA PPO |
$3,691.12
|
| 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 |
$3,491.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$4,239.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,992.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,489.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,167.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$3,741.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$3,242.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$4,239.80
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,992.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,494.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,494.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,494.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,494.00
|
| 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 SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.80
|
| Rate for Payer: EPIC Health Plan Senior |
$900.80
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,328.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
|
|
HC SIMP REP SUP WND LT 2.5 CM
|
Facility
|
IP
|
$2,252.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
900501020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Adventist Health Commercial |
$450.40
|
| Rate for Payer: Cash Price |
$1,013.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,801.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,576.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$900.80
|
| Rate for Payer: EPIC Health Plan Senior |
$900.80
|
| Rate for Payer: Galaxy Health WC |
$1,914.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,351.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,026.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,430.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,328.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.40
|
| Rate for Payer: Multiplan Commercial |
$1,689.00
|
| Rate for Payer: Networks By Design Commercial |
$1,463.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,914.20
|
|
