|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Blue Shield of California Commercial |
$18.91
|
| Rate for Payer: Blue Shield of California EPN |
$15.13
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Senior |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.99
|
| Rate for Payer: Heritage Provider Network Senior |
$20.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$986.09 |
| Max. Negotiated Rate |
$4,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,688.30
|
| Rate for Payer: Heritage Provider Network Senior |
$3,688.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,086.00
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,089.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,742.78
|
| 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 |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cash Price |
$2,996.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,541.20
|
| 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 |
$3,372.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,598.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| 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 |
$4,086.00
|
| 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 DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$12,158.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,200.60 |
| Max. Negotiated Rate |
$9,118.50 |
| Rate for Payer: Adventist Health Commercial |
$2,431.60
|
| Rate for Payer: Cash Price |
$6,686.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,230.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8,230.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,039.50
|
| Rate for Payer: Multiplan Commercial |
$9,118.50
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$12,158.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,574.13 |
| Rate for Payer: Adventist Health Commercial |
$2,431.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,352.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,686.90
|
| Rate for Payer: Cash Price |
$6,686.90
|
| Rate for Payer: Cash Price |
$6,686.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,902.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Senior |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,382.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,525.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,390.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$354.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,326.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,039.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,039.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.65
|
| Rate for Payer: Multiplan Commercial |
$9,118.50
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,820.49
|
| Rate for Payer: TriValley Medical Group Senior |
$4,820.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Senior |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$981.54
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$856.90
|
| Rate for Payer: TriValley Medical Group Senior |
$856.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$121.01 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$413.50
|
| Rate for Payer: TriValley Medical Group Senior |
$413.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Senior |
$702.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$413.50
|
| Rate for Payer: TriValley Medical Group Senior |
$413.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Senior |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$981.54
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$856.90
|
| Rate for Payer: TriValley Medical Group Senior |
$856.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Senior |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$981.54
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$856.90
|
| Rate for Payer: TriValley Medical Group Senior |
$856.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.88
|
| Rate for Payer: Heritage Provider Network Senior |
$559.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$5,498.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,276.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.00
|
| Rate for Payer: Blue Shield of California Commercial |
$504.47
|
| Rate for Payer: Blue Shield of California EPN |
$403.58
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$537.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Senior |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,860.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,602.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,498.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$895.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$981.54
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$856.90
|
| Rate for Payer: TriValley Medical Group Senior |
$856.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,078.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,432.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
OP
|
$5,935.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.76 |
| Max. Negotiated Rate |
$4,451.25 |
| Rate for Payer: Adventist Health Commercial |
$1,187.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,172.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,077.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,177.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,760.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.08
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,857.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,857.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,673.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,673.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,830.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$4,451.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,481.19
|
| Rate for Payer: TriValley Medical Group Senior |
$2,481.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,558.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,558.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
IP
|
$5,935.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,074.23 |
| Max. Negotiated Rate |
$4,451.25 |
| Rate for Payer: Adventist Health Commercial |
$1,187.00
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,017.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,017.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.75
|
| Rate for Payer: Multiplan Commercial |
$4,451.25
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$5,935.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,074.23 |
| Max. Negotiated Rate |
$4,451.25 |
| Rate for Payer: Adventist Health Commercial |
$1,187.00
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,017.99
|
| Rate for Payer: Heritage Provider Network Senior |
$4,017.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.75
|
| Rate for Payer: Multiplan Commercial |
$4,451.25
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$5,935.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.72 |
| Max. Negotiated Rate |
$4,451.25 |
| Rate for Payer: Adventist Health Commercial |
$1,187.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,172.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,077.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,039.53
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,326.49
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Cash Price |
$3,264.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,857.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,857.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,673.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,673.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,830.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,483.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$4,451.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,481.19
|
| Rate for Payer: TriValley Medical Group Senior |
$2,481.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,558.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,558.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,858.92 |
| Max. Negotiated Rate |
$15,990.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,433.64
|
| Rate for Payer: Heritage Provider Network Senior |
$14,433.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,858.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,330.00
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,990.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,646.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Cash Price |
$11,726.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,858.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,792.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,197.08
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,206.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,858.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$95.03 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| 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 |
$95.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
|
