|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,036.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,483.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,341.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,267.92
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$993.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: Dignity Health Senior |
$1,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$787.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$721.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,036.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,483.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$993.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,462.32
|
| Rate for Payer: Heritage Provider Network Senior |
$1,462.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,080.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$787.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$721.66
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$633.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$906.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$893.64
|
| Rate for Payer: Heritage Provider Network Senior |
$893.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$481.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$441.01
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$633.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$906.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$819.72
|
| Rate for Payer: Blue Shield of California EPN |
$774.84
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: Dignity Health Senior |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$611.16
|
| Rate for Payer: Heritage Provider Network Senior |
$611.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$481.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$441.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Blue Shield of California Commercial |
$181.33
|
| Rate for Payer: Blue Shield of California EPN |
$171.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$189.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Senior |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.75
|
| Rate for Payer: Heritage Provider Network Senior |
$180.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC AMPLATZ TORQUEWIRE
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$200.60
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.68
|
| Rate for Payer: Heritage Provider Network Senior |
$197.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$380.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.18
|
| Rate for Payer: Heritage Provider Network Senior |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$288.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.61
|
|
|
HC AMPLATZ TRACT MASTER
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909001099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$380.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$544.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$491.83
|
| Rate for Payer: Blue Shield of California EPN |
$464.90
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Senior |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.70
|
| Rate for Payer: Heritage Provider Network Senior |
$366.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$288.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
OP
|
$6,033.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,921.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,084.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,084.34
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,907.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,524.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,190.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,015.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION FINGER/THUMB SNGL
|
Facility
|
IP
|
$6,033.00
|
|
|
Service Code
|
CPT 26910
|
| Hospital Charge Code |
900501259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,091.97 |
| Max. Negotiated Rate |
$4,524.75 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,084.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,084.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| Rate for Payer: Multiplan Commercial |
$4,524.75
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$484.96 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.51
|
| Rate for Payer: Blue Shield of California EPN |
$2,144.31
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,261.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$484.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMPUTATION FINGER/THUMB W/V-Y
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
900501462
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
IP
|
$4,668.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
|
|
HC AMPUTATION OF TOE
|
Facility
|
OP
|
$4,668.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
900501402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$844.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$933.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,206.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cash Price |
$2,100.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,034.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,160.24
|
| Rate for Payer: Heritage Provider Network Senior |
$3,160.24
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,249.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$844.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$3,501.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,694.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,559.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC AMYLASE
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC AMYLASE BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE 24 HOURS
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.65
|
| Rate for Payer: Blue Shield of California EPN |
$39.59
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.48
|
| Rate for Payer: TriValley Medical Group Senior |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC AMYLASE URINE RANDOM
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900912193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$174.75 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$160.07
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.74
|
| Rate for Payer: Heritage Provider Network Senior |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.25
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
|
|
HC ANAEROBIC MIC PANEL
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.92 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.84
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.64
|
| Rate for Payer: Heritage Provider Network Senior |
$216.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
|
