|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
IP
|
$3,360.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$608.16 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Adventist Health Commercial |
$672.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,308.32
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,274.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,274.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Multiplan Commercial |
$2,520.00
|
|
|
HC ECHO TTE W DOPPLER COMPLETE
|
Facility
OP
|
$3,360.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
900200248
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Adventist Health Commercial |
$672.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$397.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,308.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,086.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,972.32
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,184.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: Dignity Health Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,184.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$689.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,079.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,079.84
|
| Rate for Payer: Humana Medicare |
$689.28
|
| Rate for Payer: IEHP Medi-Cal |
$374.03
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,309.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$840.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$868.49
|
| Rate for Payer: Multiplan Commercial |
$2,520.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$758.21
|
| Rate for Payer: TriValley Medical Group Senior |
$689.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$298.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC ED EVAL & MGMT
|
Facility
OP
|
$694.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.93 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$110.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$451.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.02
|
| Rate for Payer: Dignity Health Senior |
$110.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$110.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Humana Medicare |
$110.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$110.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$334.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.77
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$251.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$231.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.93
|
|
|
HC ED EVAL & MGMT
|
Facility
IP
|
$694.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$520.50 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$476.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$469.84
|
| Rate for Payer: Heritage Provider Network Senior |
$469.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.50
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
IP
|
$3,738.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.58 |
| Max. Negotiated Rate |
$2,803.50 |
| Rate for Payer: Adventist Health Commercial |
$747.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,568.01
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,530.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,530.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.50
|
| Rate for Payer: Multiplan Commercial |
$2,803.50
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
OP
|
$3,738.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.58 |
| Max. Negotiated Rate |
$2,803.50 |
| Rate for Payer: Adventist Health Commercial |
$747.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,568.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cash Price |
$1,682.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,429.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: Dignity Health Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,429.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$802.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,530.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,530.63
|
| Rate for Payer: Humana Medicare |
$802.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,801.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$934.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,011.19
|
| Rate for Payer: Multiplan Commercial |
$2,803.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,357.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,248.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.53 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,364.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$356.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,240.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.14
|
| Rate for Payer: Dignity Health Senior |
$356.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,240.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$356.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,292.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,292.39
|
| Rate for Payer: Humana Medicare |
$356.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$356.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$920.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.18
|
| Rate for Payer: Multiplan Commercial |
$1,431.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$637.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: Vantage Medical Group Senior |
$356.49
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.53 |
| Max. Negotiated Rate |
$1,431.75 |
| Rate for Payer: Adventist Health Commercial |
$381.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,311.48
|
| Rate for Payer: Cash Price |
$859.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,292.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,292.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.25
|
| Rate for Payer: Multiplan Commercial |
$1,431.75
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
IP
|
$1,140.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.18
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$771.78
|
| Rate for Payer: Heritage Provider Network Senior |
$771.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
OP
|
$1,140.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$996.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$783.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$204.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$741.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.78
|
| Rate for Payer: Dignity Health Senior |
$204.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$204.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$771.78
|
| Rate for Payer: Heritage Provider Network Senior |
$771.78
|
| Rate for Payer: Humana Medicare |
$204.35
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$204.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$549.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$241.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$257.48
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$413.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$380.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: Vantage Medical Group Senior |
$204.35
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
OP
|
$3,130.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.39 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,150.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,034.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: Dignity Health Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,034.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$553.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,119.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,119.01
|
| Rate for Payer: Humana Medicare |
$553.39
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,508.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$697.27
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,136.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,045.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
IP
|
$3,130.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$566.53 |
| Max. Negotiated Rate |
$2,347.50 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,150.31
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,119.01
|
| Rate for Payer: Heritage Provider Network Senior |
$2,119.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$782.50
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
OP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.17 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$461.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$628.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,584.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,499.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: Dignity Health Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$392.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,561.84
|
| Rate for Payer: Humana Medicare |
$392.17
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,111.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$462.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$837.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$770.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC EEG EXTENDED MONITORING LT 1 HR
|
Facility
IP
|
$2,307.00
|
|
|
Service Code
|
CPT 95812
|
| Hospital Charge Code |
900600201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.57 |
| Max. Negotiated Rate |
$1,730.25 |
| Rate for Payer: Adventist Health Commercial |
$461.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,584.91
|
| Rate for Payer: Cash Price |
$1,038.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,561.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,561.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.75
|
| Rate for Payer: Multiplan Commercial |
$1,730.25
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$482.55 |
| Max. Negotiated Rate |
$1,999.50 |
| Rate for Payer: Adventist Health Commercial |
$533.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,831.54
|
| Rate for Payer: Cash Price |
$1,199.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,804.88
|
| Rate for Payer: Heritage Provider Network Senior |
$1,804.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$482.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.50
|
| Rate for Payer: Multiplan Commercial |
$1,999.50
|
|
|
HC EGD BLLN DILA ESOPH 30MM OR GT
|
Facility
OP
|
$2,791.00
|
|
|
Service Code
|
CPT 43233
|
| Hospital Charge Code |
906743233
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$558.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,917.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cash Price |
$1,255.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,814.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,727.63
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: IEHP Medi-Cal |
$314.20
|
| Rate for Payer: IEHP Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$697.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$2,093.25
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
906743235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$349.63
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
OP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,612.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,678.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,017.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,856.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/ OR W/O COLLECTION
|
Facility
IP
|
$5,557.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
902100084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.82 |
| Max. Negotiated Rate |
$4,167.75 |
| Rate for Payer: Adventist Health Commercial |
$1,111.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,817.66
|
| Rate for Payer: Cash Price |
$2,500.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,762.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,762.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,005.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.25
|
| Rate for Payer: Multiplan Commercial |
$4,167.75
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$379.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$742.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,550.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cash Price |
$1,670.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,413.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,298.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$379.36
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$672.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,784.75
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W/SUBMUC INJ ANY SUBSTANCE
|
Facility
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43236
|
| Hospital Charge Code |
906743236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
OP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,646.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,962.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,478.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,360.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD DIAG W WO COLLECTION
|
Facility
IP
|
$4,072.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
900501432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$737.03 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Adventist Health Commercial |
$814.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,797.46
|
| Rate for Payer: Cash Price |
$1,832.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,756.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,756.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$737.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,018.00
|
| Rate for Payer: Multiplan Commercial |
$3,054.00
|
|
|
HC EGD ENDO STENT PLACEMENT
|
Facility
IP
|
$4,546.00
|
|
|
Service Code
|
CPT 43266
|
| Hospital Charge Code |
900100017
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$822.83 |
| Max. Negotiated Rate |
$3,409.50 |
| Rate for Payer: Adventist Health Commercial |
$909.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.10
|
| Rate for Payer: Cash Price |
$2,045.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,077.64
|
| Rate for Payer: Heritage Provider Network Senior |
$3,077.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$822.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,136.50
|
| Rate for Payer: Multiplan Commercial |
$3,409.50
|
|
