|
HC SINGLE AGN AB ID CLASS I
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 86832
|
| Hospital Charge Code |
903902012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Central Health Plan Commercial |
$851.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Senior |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$957.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.80
|
| Rate for Payer: Multiplan Commercial |
$798.00
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Central Health Plan Commercial |
$851.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.60
|
| Rate for Payer: EPIC Health Plan Senior |
$425.60
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$957.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.80
|
| Rate for Payer: Multiplan Commercial |
$798.00
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
|
|
HC SINGLE AGN AB ID CLASS II
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 86833
|
| Hospital Charge Code |
903902013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Adventist Health Commercial |
$212.80
|
| Rate for Payer: Adventist Health Commercial |
$157.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$325.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$665.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$325.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$743.13
|
| Rate for Payer: Blue Shield of California Commercial |
$495.18
|
| Rate for Payer: Blue Shield of California Commercial |
$670.32
|
| Rate for Payer: Blue Shield of California EPN |
$312.04
|
| Rate for Payer: Blue Shield of California EPN |
$422.41
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Central Health Plan Commercial |
$851.20
|
| Rate for Payer: Central Health Plan Commercial |
$628.80
|
| Rate for Payer: Cigna of CA HMO |
$503.04
|
| Rate for Payer: Cigna of CA HMO |
$680.96
|
| Rate for Payer: Cigna of CA PPO |
$581.64
|
| Rate for Payer: Cigna of CA PPO |
$787.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$488.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$358.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$537.57
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: EPIC Health Plan Senior |
$358.38
|
| Rate for Payer: Galaxy Health WC |
$668.10
|
| Rate for Payer: Galaxy Health WC |
$904.40
|
| Rate for Payer: Global Benefits Group Commercial |
$471.60
|
| Rate for Payer: Global Benefits Group Commercial |
$638.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$707.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$957.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$534.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$436.57
|
| Rate for Payer: Multiplan Commercial |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$798.00
|
| Rate for Payer: Networks By Design Commercial |
$691.60
|
| Rate for Payer: Networks By Design Commercial |
$510.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$325.80
|
| Rate for Payer: Prime Health Services Commercial |
$668.10
|
| Rate for Payer: Prime Health Services Commercial |
$904.40
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Prime Health Services Medicare |
$345.35
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Riverside University Health System MISP |
$358.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$638.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$471.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$638.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare All Other HMO |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare HMO Rider |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$263.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$325.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$488.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$358.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
| Rate for Payer: Vantage Medical Group Senior |
$325.80
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
OP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$702.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.82
|
| Rate for Payer: Blue Shield of California Commercial |
$830.34
|
| Rate for Payer: Blue Shield of California EPN |
$523.25
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Cigna of CA HMO |
$843.52
|
| Rate for Payer: Cigna of CA PPO |
$975.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$702.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
| Rate for Payer: Prime Health Services Medicare |
$744.95
|
| Rate for Payer: Riverside University Health System MISP |
$773.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$790.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$790.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC SINOGRAM/FISTULAGRAM ABSCESS
|
Facility
|
IP
|
$1,318.00
|
|
|
Service Code
|
CPT 76080
|
| Hospital Charge Code |
909001858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,186.20 |
| Rate for Payer: Adventist Health Commercial |
$263.60
|
| Rate for Payer: Cash Price |
$593.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,054.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$922.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.20
|
| Rate for Payer: EPIC Health Plan Senior |
$527.20
|
| Rate for Payer: Galaxy Health WC |
$1,120.30
|
| Rate for Payer: Global Benefits Group Commercial |
$790.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,186.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$836.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$777.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.60
|
| Rate for Payer: Multiplan Commercial |
$988.50
|
| Rate for Payer: Networks By Design Commercial |
$856.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,120.30
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
IP
|
$1,722.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,205.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.80
|
| Rate for Payer: EPIC Health Plan Senior |
$688.80
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,093.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
|
|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
OP
|
$1,722.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.36 |
| Max. Negotiated Rate |
$1,549.80 |
| Rate for Payer: Adventist Health Commercial |
$344.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,084.86
|
| Rate for Payer: Blue Shield of California EPN |
$683.63
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Cash Price |
$774.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,377.60
|
| Rate for Payer: Cigna of CA HMO |
$1,102.08
|
| Rate for Payer: Cigna of CA PPO |
$1,274.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,205.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$1,463.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,033.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,549.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,093.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$1,291.50
|
| Rate for Payer: Networks By Design Commercial |
$1,119.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,463.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,033.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,033.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
915350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.48
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SIO FLEX PELVISACRAL CUSTOM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L0622
|
| Hospital Charge Code |
905350622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.48
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$356.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$394.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.37
|
| Rate for Payer: Blue Shield of California Commercial |
$185.26
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
915350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$185.26
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$185.26
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$150.15
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
|
|
HC SIO FLEX PELVISACRAL PREFAB
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT L0621
|
| Hospital Charge Code |
905350621
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Adventist Health Commercial |
$94.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.37
|
| Rate for Payer: Blue Shield of California Commercial |
$185.26
|
| Rate for Payer: Blue Shield of California EPN |
$116.42
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$184.80
|
| Rate for Payer: Cigna of CA HMO |
$161.70
|
| Rate for Payer: Cigna of CA PPO |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.40
|
| Rate for Payer: EPIC Health Plan Senior |
$92.40
|
| Rate for Payer: Galaxy Health WC |
$196.35
|
| Rate for Payer: Global Benefits Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$140.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.70
|
| Rate for Payer: Multiplan Commercial |
$173.25
|
| Rate for Payer: Networks By Design Commercial |
$115.50
|
| Rate for Payer: Prime Health Services Commercial |
$196.35
|
| Rate for Payer: Riverside University Health System MISP |
$92.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.69
|
| Rate for Payer: United Healthcare All Other HMO |
$84.38
|
| Rate for Payer: United Healthcare HMO Rider |
$82.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Vantage Medical Group Senior |
$196.35
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.01 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.88
|
| Rate for Payer: Blue Shield of California Commercial |
$548.57
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Riverside University Health System MISP |
$273.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$548.57
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
915350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.01 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$280.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.88
|
| Rate for Payer: Blue Shield of California Commercial |
$548.57
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$342.00
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Riverside University Health System MISP |
$273.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC SIO W/SEMI/RIGID PLANEL CUSTOM
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT L0624
|
| Hospital Charge Code |
905350624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$548.57
|
| Rate for Payer: Blue Shield of California EPN |
$344.74
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$478.80
|
| Rate for Payer: Cigna of CA PPO |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$403.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.71
|
| Rate for Payer: United Healthcare All Other HMO |
$249.87
|
| Rate for Payer: United Healthcare HMO Rider |
$244.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.01
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.60
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.60
|
| Rate for Payer: Blue Shield of California Commercial |
$113.88
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Central Health Plan Commercial |
$168.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: EPIC Health Plan Senior |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.20
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$135.77 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Commercial |
$42.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.77
|
| Rate for Payer: Blue Shield of California Commercial |
$132.93
|
| Rate for Payer: Blue Shield of California Commercial |
$79.38
|
| Rate for Payer: Blue Shield of California EPN |
$83.77
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$168.80
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$158.25
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
