|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
OP
|
$29,272.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906820260
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$24,881.20 |
| Rate for Payer: Adventist Health Commercial |
$5,854.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15,645.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,109.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,099.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,954.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$13,172.40
|
| Rate for Payer: Cash Price |
$13,172.40
|
| Rate for Payer: Cash Price |
$13,172.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,026.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,881.20
|
| Rate for Payer: Dignity Health Senior |
$24,881.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,026.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,119.37
|
| Rate for Payer: Heritage Provider Network Senior |
$18,119.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,962.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,298.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,318.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,490.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,490.40
|
| Rate for Payer: Multiplan Commercial |
$21,954.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,881.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,881.20
|
| Rate for Payer: Vantage Medical Group Senior |
$24,881.20
|
|
|
HC ATHERECTOMY W CORO STENT ADD
|
Facility
|
IP
|
$22,307.00
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
906811462
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,037.57 |
| Max. Negotiated Rate |
$16,730.25 |
| Rate for Payer: Adventist Health Commercial |
$4,461.40
|
| Rate for Payer: Cash Price |
$10,038.15
|
| Rate for Payer: Cash Price |
$10,038.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,037.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,576.75
|
| Rate for Payer: Multiplan Commercial |
$16,730.25
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
OP
|
$21,593.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906820242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,354.05 |
| Rate for Payer: Adventist Health Commercial |
$4,318.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,834.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,354.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,876.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,194.75
|
| 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 |
$9,716.85
|
| Rate for Payer: Cash Price |
$9,716.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,354.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,354.05
|
| Rate for Payer: Dignity Health Senior |
$18,354.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,366.07
|
| Rate for Payer: Heritage Provider Network Senior |
$13,366.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,299.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,908.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,398.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,115.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,115.10
|
| Rate for Payer: Multiplan Commercial |
$16,194.75
|
| 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 |
$18,354.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,354.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18,354.05
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
OP
|
$15,843.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,884.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,713.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,882.25
|
| 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 |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,466.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,466.55
|
| Rate for Payer: Dignity Health Senior |
$13,466.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,806.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9,806.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,557.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,090.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,090.10
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
| 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 |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,466.55
|
| Rate for Payer: Vantage Medical Group Senior |
$13,466.55
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$21,593.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906820242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,908.33 |
| Max. Negotiated Rate |
$16,194.75 |
| Rate for Payer: Adventist Health Commercial |
$4,318.60
|
| Rate for Payer: Cash Price |
$9,716.85
|
| Rate for Payer: Cash Price |
$9,716.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,908.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,398.25
|
| Rate for Payer: Multiplan Commercial |
$16,194.75
|
|
|
HC ATHERECTOMY W CORO STENT ADD'L
|
Facility
|
IP
|
$15,843.00
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
906811439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,867.58 |
| Max. Negotiated Rate |
$11,882.25 |
| Rate for Payer: Adventist Health Commercial |
$3,168.60
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Cash Price |
$7,129.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,867.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,960.75
|
| Rate for Payer: Multiplan Commercial |
$11,882.25
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
IP
|
$25,407.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906820237
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,598.67 |
| Max. Negotiated Rate |
$19,055.25 |
| Rate for Payer: Adventist Health Commercial |
$5,081.40
|
| Rate for Payer: Cash Price |
$11,433.15
|
| Rate for Payer: Cash Price |
$11,433.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,598.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,351.75
|
| Rate for Payer: Multiplan Commercial |
$19,055.25
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
OP
|
$25,407.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906820237
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$5,081.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,454.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$11,433.15
|
| Rate for Payer: Cash Price |
$11,433.15
|
| Rate for Payer: Cash Price |
$11,433.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,726.93
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$837.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,598.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,351.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$19,055.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
IP
|
$19,079.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,453.30 |
| Max. Negotiated Rate |
$14,309.25 |
| Rate for Payer: Adventist Health Commercial |
$3,815.80
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,453.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,769.75
|
| Rate for Payer: Multiplan Commercial |
$14,309.25
|
|
|
HC ATHERECTOMY W PTCA
|
Facility
|
OP
|
$19,079.00
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
906811434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$3,815.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,107.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cash Price |
$8,585.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,809.90
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$837.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,453.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,769.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$14,309.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$10,164.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,861.00 |
| Rate for Payer: Adventist Health Commercial |
$2,032.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,982.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,639.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,590.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,623.00
|
| 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 |
$4,573.80
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,639.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,639.40
|
| Rate for Payer: Dignity Health Senior |
$8,639.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,291.52
|
| Rate for Payer: Heritage Provider Network Senior |
$6,291.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,848.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,839.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,114.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,114.80
|
| Rate for Payer: Multiplan Commercial |
$7,623.00
|
| 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 |
$8,639.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,639.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,639.40
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
OP
|
$8,639.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$17,861.00 |
| Rate for Payer: Adventist Health Commercial |
$1,727.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,934.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,343.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,751.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,479.25
|
| 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 |
$3,887.55
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,343.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,343.15
|
| Rate for Payer: Dignity Health Senior |
$7,343.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,347.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5,347.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,120.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,047.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,047.30
|
| Rate for Payer: Multiplan Commercial |
$6,479.25
|
| 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 |
$7,343.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,343.15
|
| Rate for Payer: Vantage Medical Group Senior |
$7,343.15
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$10,164.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906820238
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,839.68 |
| Max. Negotiated Rate |
$7,623.00 |
| Rate for Payer: Adventist Health Commercial |
$2,032.80
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: Cash Price |
$4,573.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,839.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.00
|
| Rate for Payer: Multiplan Commercial |
$7,623.00
|
|
|
HC ATHERECTOMY W PTCA ADD'L VESSEL
|
Facility
|
IP
|
$8,639.00
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
906811435
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,563.66 |
| Max. Negotiated Rate |
$6,479.25 |
| Rate for Payer: Adventist Health Commercial |
$1,727.80
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Cash Price |
$3,887.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,159.75
|
| Rate for Payer: Multiplan Commercial |
$6,479.25
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
IP
|
$30,748.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,565.39 |
| Max. Negotiated Rate |
$23,061.00 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,816.40
|
| Rate for Payer: Heritage Provider Network Senior |
$20,816.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$42,106.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$31,579.50 |
| Rate for Payer: Adventist Health Commercial |
$8,421.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,926.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$18,947.70
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27,368.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,263.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,063.61
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,621.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,526.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$31,579.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
OP
|
$30,748.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
906820163
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,123.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$13,836.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,986.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,448.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,033.01
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY AORTA
|
Facility
|
IP
|
$42,106.00
|
|
|
Service Code
|
CPT 0236T
|
| Hospital Charge Code |
909020080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,621.19 |
| Max. Negotiated Rate |
$31,579.50 |
| Rate for Payer: Adventist Health Commercial |
$8,421.20
|
| Rate for Payer: Cash Price |
$18,947.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,505.76
|
| Rate for Payer: Heritage Provider Network Senior |
$28,505.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,621.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,526.50
|
| Rate for Payer: Multiplan Commercial |
$31,579.50
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$30,748.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
906820162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,565.39 |
| Max. Negotiated Rate |
$23,061.00 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,816.40
|
| Rate for Payer: Heritage Provider Network Senior |
$20,816.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
IP
|
$36,702.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,643.06 |
| Max. Negotiated Rate |
$27,526.50 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,847.25
|
| Rate for Payer: Heritage Provider Network Senior |
$24,847.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,643.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$30,748.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
906820162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$6,149.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,123.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$13,836.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Cash Price |
$13,836.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,986.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,448.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,033.01
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,565.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,687.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$23,061.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY BRACHIOCEPHALIC
|
Facility
|
OP
|
$36,702.00
|
|
|
Service Code
|
CPT 0237T
|
| Hospital Charge Code |
909020079
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,526.50 |
| Rate for Payer: Adventist Health Commercial |
$7,340.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,214.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cash Price |
$16,515.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23,856.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,021.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,718.54
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,643.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,175.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$27,526.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| 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 |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
IP
|
$22,453.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
909020066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,063.99 |
| Max. Negotiated Rate |
$16,839.75 |
| Rate for Payer: Adventist Health Commercial |
$4,490.60
|
| Rate for Payer: Cash Price |
$10,103.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,200.68
|
| Rate for Payer: Heritage Provider Network Senior |
$15,200.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,063.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,613.25
|
| Rate for Payer: Multiplan Commercial |
$16,839.75
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
OP
|
$26,601.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
906820149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,274.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,290.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,466.02
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| 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 |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC ATHRECTOMY FEM/POP
|
Facility
|
IP
|
$26,601.00
|
|
|
Service Code
|
CPT 37225
|
| Hospital Charge Code |
906820149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,814.78 |
| Max. Negotiated Rate |
$19,950.75 |
| Rate for Payer: Adventist Health Commercial |
$5,320.20
|
| Rate for Payer: Cash Price |
$11,970.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,008.88
|
| Rate for Payer: Heritage Provider Network Senior |
$18,008.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,814.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,650.25
|
| Rate for Payer: Multiplan Commercial |
$19,950.75
|
|
