Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC PHENOBARBITAL (LUMINAL)

Facility

$185.00

Service Code	CPT 80184
Hospital Charge Code	900910409
Hospital Revenue Code	301
Min. Negotiated Rate	$101.75
Max. Negotiated Rate	$148.00
Rate for Payer: Cash Price	$83.25
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$148.00
Rate for Payer: Health Smart Auto/Commercial	$111.00
Rate for Payer: LLUH Dept of Risk Management WC	$101.75
Rate for Payer: Multiplan Commercial	$138.75

HC PHENOBARBITAL (LUMINAL)

Facility

$49.00

Service Code	CPT 80184
Hospital Charge Code	900910409
Hospital Revenue Code	301
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$15.30
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC PHENYTOIN (DILANTN)

Facility

$227.00

Service Code	CPT 80185
Hospital Charge Code	900910400
Hospital Revenue Code	301
Min. Negotiated Rate	$124.85
Max. Negotiated Rate	$181.60
Rate for Payer: Cash Price	$102.15
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$181.60
Rate for Payer: Health Smart Auto/Commercial	$136.20
Rate for Payer: LLUH Dept of Risk Management WC	$124.85
Rate for Payer: Multiplan Commercial	$170.25

HC PHENYTOIN (DILANTN)

Facility

$49.00

Service Code	CPT 80185
Hospital Charge Code	900910400
Hospital Revenue Code	301
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$29.40
Rate for Payer: Aetna of CA Government/Medicare	$29.40
Rate for Payer: Cash Price	$22.05
Rate for Payer: Cash Price	$22.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$39.20
Rate for Payer: Health Smart Auto/Commercial	$29.40
Rate for Payer: Intervalley Health Plan Commercial	$13.25
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$29.40
Rate for Payer: LLUH Dept of Risk Management WC	$26.95
Rate for Payer: Multiplan Commercial	$36.75

HC PHOSPHATIDYLGLYCEROL (PG)

Facility

$254.00

Service Code	CPT 84081
Hospital Charge Code	900910939
Hospital Revenue Code	301
Min. Negotiated Rate	$139.70
Max. Negotiated Rate	$203.20
Rate for Payer: Cash Price	$114.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$203.20
Rate for Payer: Health Smart Auto/Commercial	$152.40
Rate for Payer: LLUH Dept of Risk Management WC	$139.70
Rate for Payer: Multiplan Commercial	$190.50

HC PHOSPHATIDYLGLYCEROL (PG)

Facility

$70.00

Service Code	CPT 84081
Hospital Charge Code	900910939
Hospital Revenue Code	301
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$56.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.00
Rate for Payer: Aetna of CA Government/Medicare	$42.00
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$56.00
Rate for Payer: Health Smart Auto/Commercial	$42.00
Rate for Payer: Intervalley Health Plan Commercial	$16.52
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.00
Rate for Payer: LLUH Dept of Risk Management WC	$38.50
Rate for Payer: Multiplan Commercial	$52.50

HC PHOSPHOROUS URINE

Facility

$108.00

Service Code	CPT 84105
Hospital Charge Code	900910215
Hospital Revenue Code	301
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$86.40
Rate for Payer: Cash Price	$48.60
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$86.40
Rate for Payer: Health Smart Auto/Commercial	$64.80
Rate for Payer: LLUH Dept of Risk Management WC	$59.40
Rate for Payer: Multiplan Commercial	$81.00

HC PHOSPHOROUS URINE

Facility

$22.00

Service Code	CPT 84105
Hospital Charge Code	900910215
Hospital Revenue Code	301
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$17.60
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$13.20
Rate for Payer: Aetna of CA Government/Medicare	$13.20
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$17.60
Rate for Payer: Health Smart Auto/Commercial	$13.20
Rate for Payer: Intervalley Health Plan Commercial	$5.78
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$13.20
Rate for Payer: LLUH Dept of Risk Management WC	$12.10
Rate for Payer: Multiplan Commercial	$16.50

HC PHOSPHORUS

Facility

$31.04

Service Code	CPT 84100
Hospital Charge Code	900910252
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$24.83
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.62
Rate for Payer: Aetna of CA Government/Medicare	$18.62
Rate for Payer: Cash Price	$13.97
Rate for Payer: Cash Price	$13.97
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.83
Rate for Payer: Health Smart Auto/Commercial	$18.62
Rate for Payer: Intervalley Health Plan Commercial	$4.74
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.62
Rate for Payer: LLUH Dept of Risk Management WC	$17.07
Rate for Payer: Multiplan Commercial	$23.28

HC PHOSPHORUS

Facility

$173.00

Service Code	CPT 84100
Hospital Charge Code	900910252
Hospital Revenue Code	301
Min. Negotiated Rate	$95.15
Max. Negotiated Rate	$138.40
Rate for Payer: Cash Price	$77.85
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$138.40
Rate for Payer: Health Smart Auto/Commercial	$103.80
Rate for Payer: LLUH Dept of Risk Management WC	$95.15
Rate for Payer: Multiplan Commercial	$129.75

HC PHP COGNITIVE THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804001
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$322.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP COGNITIVE THERAPY

Facility

$430.00

Service Code	CPT 90853
Hospital Charge Code	907804001
Hospital Revenue Code	912
Min. Negotiated Rate	$236.50
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$344.00
Rate for Payer: Health Smart Auto/Commercial	$258.00
Rate for Payer: LLUH Dept of Risk Management WC	$236.50
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$322.50

HC PHP ED PROCESS GROUP

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804102
Hospital Revenue Code	912
Min. Negotiated Rate	$243.65
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$354.40
Rate for Payer: Health Smart Auto/Commercial	$265.80
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$332.25

HC PHP ED PROCESS GROUP

Facility

$443.00

Service Code	CPT 90853
Hospital Charge Code	907804102
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Cash Price	$199.35
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$243.65
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$332.25
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804379
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP MEND GROUP

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804379
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MURRIETA COGNITIVE THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804201
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP MURRIETA COGNITIVE THERAPY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804201
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MURRIETA COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804200
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MURRIETA COPING RECOVERY

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804200
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP MURRIETA FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804216
Hospital Revenue Code	912
Min. Negotiated Rate	$290.95
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$423.20
Rate for Payer: Health Smart Auto/Commercial	$317.40
Rate for Payer: LLUH Dept of Risk Management WC	$290.95
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$396.75

HC PHP MURRIETA FAMILY THERAPY

Facility

$529.00

Service Code	CPT 90847
Hospital Charge Code	907804216
Hospital Revenue Code	912
Min. Negotiated Rate	$120.20
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$176.80
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Cash Price	$238.05
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$290.95
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$120.20
Rate for Payer: Multiplan Commercial	$396.75
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MURRIETA HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804207
Hospital Revenue Code	912
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$769.00
Rate for Payer: Aetna of CA Government/Medicare	$55.76
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$600.00
Rate for Payer: Blue Shield of California Commercial	$569.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$594.00
Rate for Payer: Health Smart Auto/Commercial	$616.00
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal/Medicare Advantage	$510.00
Rate for Payer: Intervalley Health Plan Commercial	$720.00
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$588.00
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Magellan Commercial	$825.00
Rate for Payer: Managed Health Network (MHN) Commercial	$716.00
Rate for Payer: Mary Free Bed Workers' Compensation	$44.80
Rate for Payer: Multiplan Commercial	$280.50
Rate for Payer: US Behavioral Health Commercial/Medicare	$516.13

HC PHP MURRIETA HEALTH EDUCATION

Facility

$374.00

Service Code	CPT 90853
Hospital Charge Code	907804207
Hospital Revenue Code	912
Min. Negotiated Rate	$205.70
Max. Negotiated Rate	$703.72
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$703.72
Rate for Payer: Multiplan Commercial	$280.50

HC PHP MURRIETA INDIVIDUAL BRIEF

Facility

$374.00

Service Code	CPT 90832
Hospital Charge Code	907804217
Hospital Revenue Code	914
Min. Negotiated Rate	$81.95
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$102.00
Rate for Payer: Aetna of CA Government/Medicare	$102.00
Rate for Payer: Beacon Health Medi-Cal/Medicare Advantage	$400.00
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$299.20
Rate for Payer: Health Smart Auto/Commercial	$224.40
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$224.40
Rate for Payer: LLUH Dept of Risk Management WC	$205.70
Rate for Payer: Mary Free Bed Workers' Compensation	$81.95
Rate for Payer: Multiplan Commercial	$280.50

Know your out-of-pocket cost for care.

All Charges