|
HC ARTHRDSIS POST INTRBDY LMBR
|
Facility
|
IP
|
$77,449.00
|
|
|
Service Code
|
CPT 22630
|
| Hospital Charge Code |
900100963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,018.27 |
| Max. Negotiated Rate |
$58,086.75 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Cash Price |
$42,596.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,432.97
|
| Rate for Payer: Heritage Provider Network Senior |
$52,432.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,018.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
IP
|
$2,038.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.88 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,379.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,379.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
OP
|
$2,038.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,089.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.89
|
| Rate for Payer: Blue Shield of California Commercial |
$411.50
|
| Rate for Payer: Blue Shield of California EPN |
$330.92
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Cash Price |
$1,120.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,324.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$972.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
|
OP
|
$54,066.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$44,396.16 |
| Rate for Payer: Adventist Health Commercial |
$10,813.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,143.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,703.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,366.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$29,736.30
|
| Rate for Payer: Cash Price |
$29,736.30
|
| Rate for Payer: Cash Price |
$29,736.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,142.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,703.04
|
| Rate for Payer: Dignity Health Senior |
$23,366.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,366.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,466.85
|
| Rate for Payer: Heritage Provider Network Senior |
$28,740.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,931.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,366.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,396.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,785.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,871.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,516.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,441.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,441.66
|
| Rate for Payer: Multiplan Commercial |
$40,549.50
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,703.04
|
| Rate for Payer: TriValley Medical Group Senior |
$25,703.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,703.04
|
| Rate for Payer: Vantage Medical Group Senior |
$23,366.40
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
|
IP
|
$54,066.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,785.95 |
| Max. Negotiated Rate |
$40,549.50 |
| Rate for Payer: Adventist Health Commercial |
$10,813.20
|
| Rate for Payer: Cash Price |
$29,736.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,602.68
|
| Rate for Payer: Heritage Provider Network Senior |
$36,602.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,785.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,516.50
|
| Rate for Payer: Multiplan Commercial |
$40,549.50
|
|
|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
|
IP
|
$53,924.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,760.24 |
| Max. Negotiated Rate |
$40,443.00 |
| Rate for Payer: Adventist Health Commercial |
$10,784.80
|
| Rate for Payer: Cash Price |
$29,658.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,506.55
|
| Rate for Payer: Heritage Provider Network Senior |
$36,506.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,760.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,481.00
|
| Rate for Payer: Multiplan Commercial |
$40,443.00
|
|
|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
|
OP
|
$53,924.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$44,396.16 |
| Rate for Payer: Adventist Health Commercial |
$10,784.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37,045.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,703.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,366.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$29,658.20
|
| Rate for Payer: Cash Price |
$29,658.20
|
| Rate for Payer: Cash Price |
$29,658.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,050.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,703.04
|
| Rate for Payer: Dignity Health Senior |
$23,366.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,366.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,378.96
|
| Rate for Payer: Heritage Provider Network Senior |
$28,740.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,366.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44,396.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,760.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,871.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,481.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,441.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29,441.66
|
| Rate for Payer: Multiplan Commercial |
$40,443.00
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,703.04
|
| Rate for Payer: TriValley Medical Group Senior |
$25,703.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,049.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,703.04
|
| Rate for Payer: Vantage Medical Group Senior |
$23,366.40
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$617.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$793.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.22
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$750.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$750.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.95
|
| Rate for Payer: Heritage Provider Network Senior |
$714.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$550.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$209.06 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Cash Price |
$635.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$781.93
|
| Rate for Payer: Heritage Provider Network Senior |
$781.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.75
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$131.77 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.86
|
| Rate for Payer: Heritage Provider Network Senior |
$492.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$116.35 |
| Max. Negotiated Rate |
$680.65 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$389.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.22
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cash Price |
$400.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.63
|
| Rate for Payer: Heritage Provider Network Senior |
$450.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$347.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.78
|
| Rate for Payer: Heritage Provider Network Senior |
$880.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$695.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.22
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Cash Price |
$715.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$845.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.32
|
| Rate for Payer: Heritage Provider Network Senior |
$805.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$620.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
OP
|
$1,757.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$112.14 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$939.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,207.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.45
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$966.35
|
| Rate for Payer: Cash Price |
$966.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$112.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$838.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
IP
|
$1,757.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Cash Price |
$966.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$709.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$912.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.22
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$863.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$633.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$66.65 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$843.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,084.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.20
|
| Rate for Payer: Blue Shield of California Commercial |
$333.60
|
| Rate for Payer: Blue Shield of California EPN |
$268.27
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$976.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$752.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Cash Price |
$867.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,068.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,068.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
IP
|
$8,084.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.20 |
| Max. Negotiated Rate |
$6,063.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.80
|
| Rate for Payer: Cash Price |
$4,446.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,472.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,472.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$6,063.00
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
OP
|
$8,084.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,553.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$4,446.20
|
| Rate for Payer: Cash Price |
$4,446.20
|
| Rate for Payer: Cash Price |
$4,446.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,254.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,472.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,472.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,856.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$6,063.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,908.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,676.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC ASPARAGUS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.32 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$35.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ASPARAGUS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,330.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,259.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,311.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,311.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$923.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$1,452.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$641.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.60 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Cash Price |
$1,065.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,311.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,311.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.25
|
| Rate for Payer: Multiplan Commercial |
$1,452.75
|
|
