|
COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION [203438]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION [203435]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 3,000 UNIT INTRAVENOUS SOLUTION [203439]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION [203436]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS J7195
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.25
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.25
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$1.67
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.57
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION [92853]
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.02
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.02
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) INTRAVENOUS SOLUTION [92854]
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
OP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.02
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION [92855]
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
HCPCS J7189
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$2.53
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
OP
|
$12.59
|
|
|
Service Code
|
NDC 61958-1401-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$10.07 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$7.55
|
| Rate for Payer: Aetna of CA Government/Medicare |
$7.55
|
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
|
|
COBICISTAT 150 MG TABLET [207759]
|
Facility
|
IP
|
$12.59
|
|
|
Service Code
|
NDC 61958-1401-1
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$10.07 |
| Rate for Payer: Cash Price |
$6.92
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$10.07
|
| Rate for Payer: Health Smart Auto/Commercial |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.92
|
| Rate for Payer: Multiplan Commercial |
$9.44
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
OP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$44.10
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$64.62
|
| Rate for Payer: Aetna of CA Government/Medicare |
$44.10
|
| Rate for Payer: Aetna of CA Government/Medicare |
$64.62
|
| Rate for Payer: Cash Price |
$40.43
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$58.80
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$86.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$64.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$64.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$44.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
|
|
COCAINE 4 % NASAL SOLUTION [221651]
|
Facility
|
IP
|
$73.50
|
|
|
Service Code
|
HCPCS C9046
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Cash Price |
$40.43
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$86.16
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$58.80
|
| Rate for Payer: Health Smart Auto/Commercial |
$64.62
|
| Rate for Payer: Health Smart Auto/Commercial |
$44.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.23
|
| Rate for Payer: Multiplan Commercial |
$80.78
|
| Rate for Payer: Multiplan Commercial |
$55.12
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.06
|
|
|
Service Code
|
NDC 9999-3252-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 9999-3252-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.04
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.05
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.05
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0121-0775-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.02
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 0121-1775-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.08
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.08
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0121-1775-00
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.11
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0121-0775-16
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.03
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.03
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
IP
|
$0.81
|
|
|
Service Code
|
NDC 0121-1775-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.65
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [78003]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 0121-1775-05
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.49
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.49
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO |
$0.65
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$0.61
|
|
