|
HC COIL, TARGET STANDARD
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,708.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,708.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
|
|
HC COIL, TARGET STANDARD
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
909020137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$724.00 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Adventist Health Commercial |
$800.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,138.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,748.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,200.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,440.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,952.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,600.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,400.00
|
| Rate for Payer: Dignity Health Senior |
$3,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,600.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,476.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,908.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,800.00
|
| Rate for Payer: Multiplan Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,000.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,400.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,400.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,084.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,379.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,903.20
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,535.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,414.10
|
| Rate for Payer: Heritage Provider Network Senior |
$2,414.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,860.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,950.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC COIL ULTIPAQ
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.90 |
| Max. Negotiated Rate |
$2,925.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$62.96
|
| Rate for Payer: Heritage Provider Network Senior |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
|
|
HC COLD AGGLUTININS SCREEN
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
900904504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Adventist Health Commercial |
$18.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.66
|
| Rate for Payer: Blue Shield of California Commercial |
$53.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.24
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.88
|
| Rate for Payer: Dignity Health Senior |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.57
|
| Rate for Payer: Heritage Provider Network Senior |
$57.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$69.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.88
|
| Rate for Payer: Vantage Medical Group Senior |
$8.07
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC COLD AGGLUTININ TITER
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 86157
|
| Hospital Charge Code |
900904451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$122.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.63
|
| Rate for Payer: Blue Shield of California Commercial |
$64.92
|
| Rate for Payer: Blue Shield of California EPN |
$52.07
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cash Price |
$125.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.87
|
| Rate for Payer: Dignity Health Senior |
$8.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.06
|
| Rate for Payer: TriValley Medical Group Senior |
$8.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.87
|
| Rate for Payer: Vantage Medical Group Senior |
$8.06
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$420.76 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$744.15
|
| Rate for Payer: Aetna of CA Gatekeeper |
$871.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,246.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,361.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$729.63
|
| Rate for Payer: Blue Shield of California EPN |
$729.63
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$834.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,542.75
|
| Rate for Payer: Dignity Health Senior |
$1,542.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.35
|
| Rate for Payer: Heritage Provider Network Senior |
$840.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$907.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,270.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$655.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$600.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.75
|
|
|
HC COLLAR MULTI-POST (SOMI, GUILFORD)
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT L0190
|
| Hospital Charge Code |
905350190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$363.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$871.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$729.63
|
| Rate for Payer: Blue Shield of California EPN |
$729.63
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cash Price |
$998.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$834.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$840.35
|
| Rate for Payer: Heritage Provider Network Senior |
$840.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$907.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$907.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.75
|
| Rate for Payer: Multiplan Commercial |
$1,361.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$655.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$600.95
|
|
|
HC COLLECT BLOOD FROM ESTAB DEVICE
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
901200035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$342.75 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.39
|
| Rate for Payer: Heritage Provider Network Senior |
$309.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.25
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
|
|
HC COLLECT BLOOD FROM ESTAB DEVICE
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
901200035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$244.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.77
|
| Rate for Payer: Blue Shield of California Commercial |
$278.77
|
| Rate for Payer: Blue Shield of California EPN |
$223.02
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$297.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$282.88
|
| Rate for Payer: Heritage Provider Network Senior |
$282.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$217.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$163.78
|
| Rate for Payer: TriValley Medical Group Senior |
$163.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$228.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$228.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC COLONOSCOPY DILATE STRICTURE
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 45386
|
| Hospital Charge Code |
906745386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONOSCOPY DILATE STRICTURE
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 45386
|
| Hospital Charge Code |
906745386
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,291.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY DX W WO COLLECT
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
906745378
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$855.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,938.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$2,352.35
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,780.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,647.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$478.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,040.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$3,207.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLONOSCOPY DX W WO COLLECT
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
906745378
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$774.14 |
| Max. Negotiated Rate |
$3,207.75 |
| Rate for Payer: Adventist Health Commercial |
$855.40
|
| Rate for Payer: Cash Price |
$2,352.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,895.53
|
| Rate for Payer: Heritage Provider Network Senior |
$2,895.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,069.25
|
| Rate for Payer: Multiplan Commercial |
$3,207.75
|
|
|
HC COLONOSCOPY STOMA W BX
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44389
|
| Hospital Charge Code |
906744389
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$293.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY STOMA W BX
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44389
|
| Hospital Charge Code |
906744389
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONOSCOPY STOMA W RMVL
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44392
|
| Hospital Charge Code |
906744392
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONOSCOPY STOMA W RMVL
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44392
|
| Hospital Charge Code |
906744392
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$387.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC COLONOSCOPY STOMA W STNT PLCMT
|
Facility
|
OP
|
$5,143.00
|
|
|
Service Code
|
CPT 44402
|
| Hospital Charge Code |
906744402
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,345.46 |
| Rate for Payer: Adventist Health Commercial |
$1,028.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,533.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| 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 |
$2,828.65
|
| Rate for Payer: Cash Price |
$2,828.65
|
| Rate for Payer: Cash Price |
$2,828.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,342.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Senior |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,563.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,183.52
|
| Rate for Payer: Heritage Provider Network Senior |
$9,303.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,453.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,698.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,857.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC COLONOSCOPY STOMA W STNT PLCMT
|
Facility
|
IP
|
$5,143.00
|
|
|
Service Code
|
CPT 44402
|
| Hospital Charge Code |
906744402
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$930.88 |
| Max. Negotiated Rate |
$3,857.25 |
| Rate for Payer: Adventist Health Commercial |
$1,028.60
|
| Rate for Payer: Cash Price |
$2,828.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,481.81
|
| Rate for Payer: Heritage Provider Network Senior |
$3,481.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.75
|
| Rate for Payer: Multiplan Commercial |
$3,857.25
|
|
|
HC COLONOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$1,681.00
|
|
|
Service Code
|
CPT 44388
|
| Hospital Charge Code |
906744388
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,154.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| 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 |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,092.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,040.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$801.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC COLONOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44388
|
| Hospital Charge Code |
906744388
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
|
HC COLONOSCOPY W ABLATION
|
Facility
|
IP
|
$1,681.00
|
|
|
Service Code
|
CPT 44401
|
| Hospital Charge Code |
906744401
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$304.26 |
| Max. Negotiated Rate |
$1,260.75 |
| Rate for Payer: Adventist Health Commercial |
$336.20
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,138.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.25
|
| Rate for Payer: Multiplan Commercial |
$1,260.75
|
|
