|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,033.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,870.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,733.50
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$5,388.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$975.23 |
| Max. Negotiated Rate |
$4,041.00 |
| Rate for Payer: Adventist Health Commercial |
$1,077.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,701.56
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,647.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,647.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$975.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.00
|
| Rate for Payer: Multiplan Commercial |
$4,041.00
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$5,388.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,077.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,701.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,502.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: Dignity Health Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,544.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,647.68
|
| Rate for Payer: Heritage Provider Network Senior |
$3,647.68
|
| Rate for Payer: Humana Medicare |
$2,544.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,597.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$975.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,002.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,347.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,206.54
|
| Rate for Payer: Multiplan Commercial |
$4,041.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,956.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,800.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$541.36
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.48
|
| Rate for Payer: Heritage Provider Network Senior |
$533.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$541.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cash Price |
$354.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$512.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$533.48
|
| Rate for Payer: Heritage Provider Network Senior |
$533.48
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$591.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$286.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$263.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$94.39
|
| Rate for Payer: Blue Shield of California EPN |
$89.22
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Senior |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$60.80
|
| Rate for Payer: TriValley Medical Group Senior |
$60.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$266.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$915.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$901.76
|
| Rate for Payer: Heritage Provider Network Senior |
$901.76
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$642.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$999.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$483.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$445.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.09 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Adventist Health Commercial |
$266.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$915.08
|
| Rate for Payer: Cash Price |
$599.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$901.76
|
| Rate for Payer: Heritage Provider Network Senior |
$901.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.00
|
| Rate for Payer: Multiplan Commercial |
$999.00
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$488.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$272.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$563.25 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$2,208.75 |
| Rate for Payer: Adventist Health Commercial |
$589.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,023.22
|
| Rate for Payer: Cash Price |
$1,325.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,993.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,993.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.25
|
| Rate for Payer: Multiplan Commercial |
$2,208.75
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$589.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,023.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,325.25
|
| Rate for Payer: Cash Price |
$1,325.25
|
| Rate for Payer: Cash Price |
$1,325.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,914.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,993.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,993.76
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,419.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$2,208.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,069.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$983.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$563.25 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.93 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$150.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cash Price |
$337.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$488.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$508.43
|
| Rate for Payer: Heritage Provider Network Senior |
$508.43
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$361.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$563.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$272.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$250.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$1,058.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,636.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,499.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,911.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,969.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,440.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,499.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,499.05
|
| Rate for Payer: Dignity Health Senior |
$4,499.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,175.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,276.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,276.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,551.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,499.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,499.05
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$958.03 |
| Max. Negotiated Rate |
$3,969.75 |
| Rate for Payer: Adventist Health Commercial |
$1,058.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,636.29
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,583.36
|
| Rate for Payer: Heritage Provider Network Senior |
$3,583.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$5,146.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$931.43 |
| Max. Negotiated Rate |
$3,859.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,535.30
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,483.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,483.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.50
|
| Rate for Payer: Multiplan Commercial |
$3,859.50
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$931.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,029.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,535.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cash Price |
$2,315.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,344.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,483.84
|
| Rate for Payer: Heritage Provider Network Senior |
$3,483.84
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,480.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,286.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$3,859.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,868.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,719.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,420.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,344.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,344.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$996.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$750.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$690.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.31 |
| Max. Negotiated Rate |
$1,551.00 |
| Rate for Payer: Adventist Health Commercial |
$413.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,420.72
|
| Rate for Payer: Cash Price |
$930.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,400.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.00
|
| Rate for Payer: Multiplan Commercial |
$1,551.00
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: Adventist Health Commercial |
$528.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,814.37
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,787.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,787.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.25
|
| Rate for Payer: Multiplan Commercial |
$1,980.75
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$528.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,814.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cash Price |
$1,188.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,716.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: Dignity Health Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,550.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,787.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,787.96
|
| Rate for Payer: Humana Medicare |
$3,550.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,272.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,189.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,473.33
|
| Rate for Payer: Multiplan Commercial |
$1,980.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$958.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$882.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,356.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$2,002.60 |
| Rate for Payer: Adventist Health Commercial |
$471.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,618.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,295.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,767.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,463.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,382.97
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cash Price |
$1,060.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,531.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,002.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,002.60
|
| Rate for Payer: Dignity Health Senior |
$2,002.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,531.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,458.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,135.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.00
|
| Rate for Payer: Multiplan Commercial |
$1,767.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,002.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,002.60
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,852.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$516.21 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Adventist Health Commercial |
$570.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,959.32
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,930.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,930.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.00
|
| Rate for Payer: Multiplan Commercial |
$2,139.00
|
|
