|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$322.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cash Price |
$332.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$288.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$217.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$199.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Senior |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$128.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.12
|
| Rate for Payer: Heritage Provider Network Senior |
$73.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$44.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$57.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Senior |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.85
|
| Rate for Payer: Heritage Provider Network Senior |
$66.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.54
|
| Rate for Payer: Heritage Provider Network Senior |
$166.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$159.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Senior |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$152.27
|
| Rate for Payer: Heritage Provider Network Senior |
$152.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$117.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Adventist Health Commercial |
$58.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$196.33
|
| Rate for Payer: Heritage Provider Network Senior |
$196.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$118.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$155.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cash Price |
$159.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$188.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.50
|
| Rate for Payer: Dignity Health Senior |
$246.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.51
|
| Rate for Payer: Heritage Provider Network Senior |
$179.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$138.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.00
|
| Rate for Payer: Multiplan Commercial |
$217.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.50
|
| Rate for Payer: Vantage Medical Group Senior |
$246.50
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,658.14 |
| Max. Negotiated Rate |
$6,870.75 |
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,202.00
|
| Rate for Payer: Heritage Provider Network Senior |
$6,202.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.25
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,293.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,954.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,670.66
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,290.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$4,862.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$880.02 |
| Max. Negotiated Rate |
$3,646.50 |
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Cash Price |
$2,674.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,291.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3,291.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| Rate for Payer: Multiplan Commercial |
$3,646.50
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$4,862.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$972.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,340.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,674.10
|
| Rate for Payer: Cash Price |
$2,674.10
|
| Rate for Payer: Cash Price |
$2,674.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,160.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,009.58
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$880.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,215.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,646.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.65
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.19
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,136.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.65
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Cash Price |
$1,555.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Senior |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,979.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,979.25
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,021.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$936.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$568.50 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$513.17
|
| Rate for Payer: Heritage Provider Network Senior |
$513.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$151.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$520.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$568.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Cash Price |
$416.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$492.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$644.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$644.30
|
| Rate for Payer: Dignity Health Senior |
$644.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.20
|
| Rate for Payer: Heritage Provider Network Senior |
$469.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.60
|
| Rate for Payer: Multiplan Commercial |
$568.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$644.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$644.30
|
| Rate for Payer: Vantage Medical Group Senior |
$644.30
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Dignity Health Senior |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$515.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Cash Price |
$405.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$1,928.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,324.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,638.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,060.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,446.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,253.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,638.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,638.80
|
| Rate for Payer: Dignity Health Senior |
$1,638.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,193.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,193.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$291.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$919.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,349.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,349.60
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,638.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,638.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,638.80
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Adventist Health Commercial |
$396.80
|
| Rate for Payer: Cash Price |
$1,091.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,343.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,343.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.00
|
| Rate for Payer: Multiplan Commercial |
$1,488.00
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$396.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,363.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,091.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,488.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,091.20
|
| Rate for Payer: Cash Price |
$1,091.20
|
| Rate for Payer: Cash Price |
$1,091.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,289.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,686.40
|
| Rate for Payer: Dignity Health Senior |
$1,686.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,228.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,228.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$291.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,388.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.80
|
| Rate for Payer: Multiplan Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,686.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,686.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,686.40
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$1,928.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.97 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: Adventist Health Commercial |
$385.60
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,305.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,305.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.00
|
| Rate for Payer: Multiplan Commercial |
$1,446.00
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$691.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cash Price |
$553.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$653.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Senior |
$855.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.71
|
| Rate for Payer: Heritage Provider Network Senior |
$622.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$479.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$704.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.11
|
| Rate for Payer: Heritage Provider Network Senior |
$662.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.50
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
|
