|
HC RESPIRATORY MINI PANEL
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$821.55 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$209.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.70
|
| Rate for Payer: Blue Shield of California Commercial |
$821.55
|
| Rate for Payer: Blue Shield of California EPN |
$658.95
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.89
|
| Rate for Payer: Dignity Health Senior |
$142.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$142.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.65
|
| Rate for Payer: Heritage Provider Network Senior |
$242.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$142.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$186.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.71
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$142.63
|
| Rate for Payer: TriValley Medical Group Senior |
$142.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Vantage Medical Group Senior |
$142.63
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
|
HC RESPIRATORY PANEL, NUCLEIC ACID
|
Facility
|
OP
|
$1,540.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900913642
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.86 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Adventist Health Commercial |
$308.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$823.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,012.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,001.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.69
|
| Rate for Payer: Heritage Provider Network Senior |
$953.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$734.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.14
|
| Rate for Payer: Multiplan Commercial |
$1,155.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC RESPIRATORY PANEL, NUCLEIC ACID
|
Facility
|
IP
|
$1,540.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900913642
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.86 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Adventist Health Commercial |
$308.14
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.17
|
| Rate for Payer: Multiplan Commercial |
$1,155.52
|
|
|
HC RESP VIRUS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,540.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900912337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.86 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Adventist Health Commercial |
$308.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$823.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,058.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,012.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,299.96
|
| Rate for Payer: Blue Shield of California EPN |
$2,646.84
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,001.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,001.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$416.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$953.69
|
| Rate for Payer: Heritage Provider Network Senior |
$953.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$600.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$734.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.14
|
| Rate for Payer: Multiplan Commercial |
$1,155.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$416.78
|
| Rate for Payer: TriValley Medical Group Senior |
$416.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$450.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$450.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC RESP VIRUS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,540.69
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900912337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$278.86 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Adventist Health Commercial |
$308.14
|
| Rate for Payer: Cash Price |
$847.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,043.05
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.17
|
| Rate for Payer: Multiplan Commercial |
$1,155.52
|
|
|
HC RESTING THALLIUM
|
Facility
|
OP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$286.09 |
| Max. Negotiated Rate |
$2,488.11 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,524.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,960.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,658.74
|
| Rate for Payer: Blue Shield of California Commercial |
$811.44
|
| Rate for Payer: Blue Shield of California EPN |
$652.53
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,854.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,824.61
|
| Rate for Payer: Dignity Health Senior |
$1,658.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,854.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,658.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,766.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,766.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,658.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,360.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,907.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,090.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,090.01
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,824.61
|
| Rate for Payer: TriValley Medical Group Senior |
$1,658.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,426.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,426.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,488.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,824.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1,658.74
|
|
|
HC RESTING THALLIUM
|
Facility
|
IP
|
$2,853.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$2,139.75 |
| Rate for Payer: Adventist Health Commercial |
$570.60
|
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,931.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,931.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$516.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.25
|
| Rate for Payer: Multiplan Commercial |
$2,139.75
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.41
|
| Rate for Payer: Heritage Provider Network Senior |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.77
|
| Rate for Payer: Blue Shield of California Commercial |
$44.93
|
| Rate for Payer: Blue Shield of California EPN |
$36.04
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.38
|
| Rate for Payer: Heritage Provider Network Senior |
$64.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.27
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$27.77
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$80.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: Dignity Health Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.76
|
| Rate for Payer: Heritage Provider Network Senior |
$76.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.31
|
| Rate for Payer: TriValley Medical Group Senior |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$607.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$780.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$738.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$738.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$541.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$408.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,358.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$5,090.80
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,016.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,729.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,415.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,675.34 |
| Max. Negotiated Rate |
$6,942.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,266.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,266.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,358.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$5,090.80
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,016.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,729.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,415.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
| 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 |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$9,256.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,675.34 |
| Max. Negotiated Rate |
$6,942.00 |
| Rate for Payer: Adventist Health Commercial |
$1,851.20
|
| Rate for Payer: Cash Price |
$5,090.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,266.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,266.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,942.00
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.26 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$675.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$868.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.53
|
| Rate for Payer: Blue Shield of California Commercial |
$306.48
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$821.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$821.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$782.42
|
| Rate for Payer: Heritage Provider Network Senior |
$782.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$602.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$855.73
|
| Rate for Payer: Heritage Provider Network Senior |
$855.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.00
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$1,258.50 |
| Rate for Payer: Adventist Health Commercial |
$335.60
|
| Rate for Payer: Cash Price |
$922.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,136.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.50
|
| Rate for Payer: Multiplan Commercial |
$1,258.50
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$1,258.50 |
| Rate for Payer: Adventist Health Commercial |
$335.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$896.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,152.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$601.05
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$922.90
|
| Rate for Payer: Cash Price |
$922.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,090.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Senior |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,090.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$453.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,038.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,038.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$800.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$521.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$571.75
|
| Rate for Payer: Multiplan Commercial |
$1,258.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.77
|
| Rate for Payer: TriValley Medical Group Senior |
$453.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$294.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$81.18
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$136.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California EPN |
$79.60
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: Dignity Health Senior |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.67
|
| Rate for Payer: Heritage Provider Network Senior |
$91.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$138.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$138.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California EPN |
$79.60
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$91.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.67
|
| Rate for Payer: Heritage Provider Network Senior |
$91.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$65.56
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
|
IP
|
$30,068.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.31 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Adventist Health Commercial |
$6,013.60
|
| Rate for Payer: Cash Price |
$16,537.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,356.04
|
| Rate for Payer: Heritage Provider Network Senior |
$20,356.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,442.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,517.00
|
| Rate for Payer: Multiplan Commercial |
$22,551.00
|
|
