|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$3,672.90 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,632.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,632.40
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,554.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,526.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$3,672.90 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: Cigna of CA HMO |
$2,611.84
|
| Rate for Payer: Cigna of CA PPO |
$3,019.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,448.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,040.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,040.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,040.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,040.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$816.20 |
| Max. Negotiated Rate |
$3,672.90 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,632.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,632.40
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,554.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,526.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
|
|
HC REPLC COMP NON/TUN CNTRL INSRT
|
Facility
|
OP
|
$4,081.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
909080018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.58 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Cash Price |
$1,836.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,264.80
|
| Rate for Payer: Cigna of CA HMO |
$2,611.84
|
| Rate for Payer: Cigna of CA PPO |
$3,019.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$3,468.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,448.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,672.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$816.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$2,652.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$3,468.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,448.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
OP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,105.40 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,191.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: Cigna of CA HMO |
$3,537.28
|
| Rate for Payer: Cigna of CA PPO |
$4,089.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,786.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,686.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,596.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,262.74
|
| Rate for Payer: Riverside University Health System MISP |
$1,310.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
|
IP
|
$5,527.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,105.40 |
| Max. Negotiated Rate |
$4,974.30 |
| Rate for Payer: Adventist Health Commercial |
$1,105.40
|
| Rate for Payer: Cash Price |
$2,487.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,421.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.80
|
| Rate for Payer: Galaxy Health WC |
$4,697.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,316.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,974.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,686.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,105.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,421.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,105.40
|
| Rate for Payer: Multiplan Commercial |
$4,145.25
|
| Rate for Payer: Networks By Design Commercial |
$3,592.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.95
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$2,744.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: Cigna of CA HMO |
$4,283.52
|
| Rate for Payer: Cigna of CA PPO |
$4,952.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,015.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,015.80
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,338.60 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,677.20
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,550.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,338.60 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,677.20
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,550.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,338.60 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,677.20
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,550.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
901200086
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.86 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: Cigna of CA HMO |
$4,283.52
|
| Rate for Payer: Cigna of CA PPO |
$4,952.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.86 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: Cigna of CA HMO |
$4,283.52
|
| Rate for Payer: Cigna of CA PPO |
$4,952.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
IP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,338.60 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,677.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,677.20
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,550.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,142.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
|
OP
|
$6,693.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$6,023.70 |
| Rate for Payer: Adventist Health Commercial |
$1,338.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Cash Price |
$3,011.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,354.40
|
| Rate for Payer: Cigna of CA HMO |
$4,283.52
|
| Rate for Payer: Cigna of CA PPO |
$4,952.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$5,689.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,015.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,023.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$5,019.75
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$4,350.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$5,689.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,015.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,346.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,346.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,346.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.92
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,984.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,482.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.00
|
| Rate for Payer: Multiplan Commercial |
$3,735.00
|
| Rate for Payer: Networks By Design Commercial |
$3,237.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
905356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,630.95 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,924.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.92
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,984.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,482.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,284.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,490.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,735.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,992.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
IP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$996.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.92
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,984.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,482.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,897.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.00
|
| Rate for Payer: Multiplan Commercial |
$3,735.00
|
| Rate for Payer: Networks By Design Commercial |
$3,237.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
|
|
HC REPLC SOCKT ABOVE ELBOW DISA
|
Facility
|
OP
|
$4,980.00
|
|
|
Service Code
|
CPT L6884
|
| Hospital Charge Code |
915356884
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,630.95 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$2,041.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,739.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,924.75
|
| Rate for Payer: Blue Shield of California Commercial |
$3,849.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.92
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,984.00
|
| Rate for Payer: Cigna of CA HMO |
$3,486.00
|
| Rate for Payer: Cigna of CA PPO |
$3,486.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,233.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,233.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,992.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,992.00
|
| Rate for Payer: Galaxy Health WC |
$4,233.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,988.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,482.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,284.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,490.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,321.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,628.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,082.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$3,735.00
|
| Rate for Payer: Networks By Design Commercial |
$2,490.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,233.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,992.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,988.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,988.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,868.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,819.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1,779.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,630.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,233.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,233.00
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
915356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$941.56 |
| Max. Negotiated Rate |
$2,587.50 |
| Rate for Payer: Adventist Health Commercial |
$1,178.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,581.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,688.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,443.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,443.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,896.94
|
| Rate for Payer: InnovAge PACE Commercial |
$1,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,012.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,725.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,443.75
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$941.56 |
| Max. Negotiated Rate |
$2,587.50 |
| Rate for Payer: Adventist Health Commercial |
$1,178.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,581.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,156.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,688.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,443.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,443.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,896.94
|
| Rate for Payer: InnovAge PACE Commercial |
$1,437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,012.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,012.50
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,437.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,150.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,725.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,725.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,443.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,443.75
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
905356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$2,587.50 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
|
|
HC REPLC SOCKT BELOW E/W DISA
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT L6883
|
| Hospital Charge Code |
915356883
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$2,587.50 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,222.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,449.00
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,300.00
|
| Rate for Payer: Cigna of CA HMO |
$2,012.50
|
| Rate for Payer: Cigna of CA PPO |
$2,012.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,150.00
|
| Rate for Payer: Galaxy Health WC |
$2,443.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,725.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,587.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,917.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,779.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$575.00
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Networks By Design Commercial |
$1,868.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,443.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,027.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$941.56
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
OP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
905356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,326.89 |
| Max. Negotiated Rate |
$6,394.50 |
| Rate for Payer: Adventist Health Commercial |
$2,913.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,907.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,328.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,172.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5,492.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,580.92
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,684.00
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,039.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,039.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,394.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,686.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,552.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,176.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,913.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,973.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,973.50
|
| Rate for Payer: Multiplan Commercial |
$5,328.75
|
| Rate for Payer: Networks By Design Commercial |
$3,552.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,842.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,263.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,263.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,039.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,039.25
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
IP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
905356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$6,394.50 |
| Rate for Payer: Adventist Health Commercial |
$1,421.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,492.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,580.92
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,684.00
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,394.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.00
|
| Rate for Payer: Multiplan Commercial |
$5,328.75
|
| Rate for Payer: Networks By Design Commercial |
$4,618.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
|
|
HC REPLC SOCKT SHLDR DIS/INTERC
|
Facility
|
IP
|
$7,105.00
|
|
|
Service Code
|
CPT L6885
|
| Hospital Charge Code |
915356885
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,421.00 |
| Max. Negotiated Rate |
$6,394.50 |
| Rate for Payer: Adventist Health Commercial |
$1,421.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,492.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,580.92
|
| Rate for Payer: Cash Price |
$3,197.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,684.00
|
| Rate for Payer: Cigna of CA HMO |
$4,973.50
|
| Rate for Payer: Cigna of CA PPO |
$4,973.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,842.00
|
| Rate for Payer: Galaxy Health WC |
$6,039.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,263.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,394.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,739.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,397.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.00
|
| Rate for Payer: Multiplan Commercial |
$5,328.75
|
| Rate for Payer: Networks By Design Commercial |
$4,618.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,039.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,666.51
|
| Rate for Payer: United Healthcare All Other HMO |
$2,595.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2,539.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.89
|
|
