|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
OP
|
$11,663.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,332.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,012.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$6,414.65
|
| Rate for Payer: Cash Price |
$6,414.65
|
| Rate for Payer: Cash Price |
$6,414.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,580.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,219.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5,070.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$873.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,832.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,915.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$8,747.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,534.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4,534.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC RMV FOREIGN BDY,HIP SUBCU/DEEP
|
Facility
|
IP
|
$11,663.00
|
|
|
Service Code
|
CPT 27087
|
| Hospital Charge Code |
909020033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,111.00 |
| Max. Negotiated Rate |
$8,747.25 |
| Rate for Payer: Adventist Health Commercial |
$2,332.60
|
| Rate for Payer: Cash Price |
$6,414.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,895.85
|
| Rate for Payer: Heritage Provider Network Senior |
$7,895.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,915.75
|
| Rate for Payer: Multiplan Commercial |
$8,747.25
|
|
|
HC RMVL AND RPLCMT PERM CCM DFIB PG
|
Facility
|
IP
|
$64,789.00
|
|
|
Service Code
|
CPT 0923T
|
| Hospital Charge Code |
906811511
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$4,982.00 |
| Max. Negotiated Rate |
$48,591.75 |
| Rate for Payer: Adventist Health Commercial |
$12,957.80
|
| Rate for Payer: Cash Price |
$35,633.95
|
| Rate for Payer: Cash Price |
$35,633.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,726.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,197.25
|
| Rate for Payer: Multiplan Commercial |
$48,591.75
|
|
|
HC RMVL AND RPLCMT PERM CCM DFIB PG
|
Facility
|
OP
|
$64,789.00
|
|
|
Service Code
|
CPT 0923T
|
| Hospital Charge Code |
906811511
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$54,188.25 |
| Rate for Payer: Adventist Health Commercial |
$12,957.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44,510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,520.13
|
| 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 |
$35,633.95
|
| Rate for Payer: Cash Price |
$35,633.95
|
| Rate for Payer: Cash Price |
$35,633.95
|
| Rate for Payer: Cash Price |
$35,633.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42,112.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,372.14
|
| Rate for Payer: Dignity Health Senior |
$28,520.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$28,520.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$40,104.39
|
| Rate for Payer: Heritage Provider Network Senior |
$35,079.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28,520.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54,188.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,726.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32,798.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,197.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,935.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35,935.36
|
| Rate for Payer: Multiplan Commercial |
$48,591.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$31,372.14
|
| Rate for Payer: TriValley Medical Group Senior |
$28,520.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,780.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,372.14
|
| Rate for Payer: Vantage Medical Group Senior |
$28,520.13
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
IP
|
$4,649.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.47 |
| Max. Negotiated Rate |
$3,486.75 |
| Rate for Payer: Adventist Health Commercial |
$929.80
|
| Rate for Payer: Cash Price |
$2,556.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,147.37
|
| Rate for Payer: Heritage Provider Network Senior |
$3,147.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$841.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,162.25
|
| Rate for Payer: Multiplan Commercial |
$3,486.75
|
|
|
HC RMVL BRONCH VALVE ADDL LOBES
|
Facility
|
OP
|
$4,649.00
|
|
|
Service Code
|
CPT 31649
|
| Hospital Charge Code |
900531649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$929.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,193.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,556.95
|
| Rate for Payer: Cash Price |
$2,556.95
|
| Rate for Payer: Cash Price |
$2,556.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,021.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,877.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,695.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,163.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$841.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,162.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,486.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,410.22
|
| Rate for Payer: TriValley Medical Group Senior |
$2,410.22
|
| 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 |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
IP
|
$8,904.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,611.62 |
| Max. Negotiated Rate |
$6,678.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.80
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,028.01
|
| Rate for Payer: Heritage Provider Network Senior |
$6,028.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,611.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$6,678.00
|
|
|
HC RMVL BRONCH VALVE INIT LOBE
|
Facility
|
OP
|
$8,904.00
|
|
|
Service Code
|
CPT 31648
|
| Hospital Charge Code |
900531648
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,117.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,684.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cash Price |
$4,897.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,787.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,153.10
|
| Rate for Payer: Dignity Health Senior |
$4,684.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,684.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,511.58
|
| Rate for Payer: Heritage Provider Network Senior |
$5,762.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,684.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,900.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,611.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,387.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,902.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,902.65
|
| Rate for Payer: Multiplan Commercial |
$6,678.00
|
| Rate for Payer: Multiplan WC |
$7,464.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,153.10
|
| Rate for Payer: TriValley Medical Group Senior |
$5,153.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,026.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,153.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,684.64
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
IP
|
$5,376.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$973.06 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,639.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,639.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
|
|
HC RMVL CVA OBSTRUC INTRALUMINA
|
Facility
|
OP
|
$5,376.00
|
|
|
Service Code
|
CPT 36596
|
| Hospital Charge Code |
909081382
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,693.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,327.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$270.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$973.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,344.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
|
|
HC RMVL EAR WX IRRGTN/LAVAGE UNI
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
900569209
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.31
|
| Rate for Payer: Heritage Provider Network Senior |
$129.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Multiplan WC |
$120.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$68.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$63.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$366.13
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| 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 |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| 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 |
$513.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.80
|
| 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 RMVL EMBEDDED FB MOUTH SIMPLE
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
900501579
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Cash Price |
$376.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$651.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$477.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$360.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$331.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC RMVL FB CONJUNCTIVA EMBEDDED
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
900501177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.36 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Adventist Health Commercial |
$200.40
|
| Rate for Payer: Cash Price |
$551.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$678.35
|
| Rate for Payer: Heritage Provider Network Senior |
$678.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$751.50
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.72 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$418.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$508.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$373.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$259.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC RMVL FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
900501178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.72 |
| Max. Negotiated Rate |
$587.25 |
| Rate for Payer: Adventist Health Commercial |
$156.60
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$530.09
|
| Rate for Payer: Heritage Provider Network Senior |
$530.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.78 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$561.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$722.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$683.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$711.53
|
| Rate for Payer: Heritage Provider Network Senior |
$711.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$501.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$788.25
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$347.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
900501179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.23 |
| Max. Negotiated Rate |
$788.25 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$711.53
|
| Rate for Payer: Heritage Provider Network Senior |
$711.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.75
|
| Rate for Payer: Multiplan Commercial |
$788.25
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
IP
|
$5,299.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$959.12 |
| Max. Negotiated Rate |
$3,974.25 |
| Rate for Payer: Adventist Health Commercial |
$1,059.80
|
| Rate for Payer: Cash Price |
$2,914.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,587.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,587.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.75
|
| Rate for Payer: Multiplan Commercial |
$3,974.25
|
|
|
HC RMVL F.B. DEEP,THIGH/KNEE AREA
|
Facility
|
OP
|
$5,299.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
900501311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,059.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,640.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,914.45
|
| Rate for Payer: Cash Price |
$2,914.45
|
| Rate for Payer: Cash Price |
$2,914.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,444.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,587.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,587.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,527.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$3,974.25
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,906.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,754.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$408.75 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.96
|
| Rate for Payer: Heritage Provider Network Senior |
$368.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.25
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
|
|
HC RMVL FB EXT AUDITORY CANAL
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
900501185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$109.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$291.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$374.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$354.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Senior |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.96
|
| Rate for Payer: Heritage Provider Network Senior |
$368.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$259.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.36
|
| Rate for Payer: Multiplan Commercial |
$408.75
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$196.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$180.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RMVL F.B. FOOT, COMPLICATED
|
Facility
|
IP
|
$2,061.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
900501715
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.04 |
| Max. Negotiated Rate |
$1,545.75 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.25
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
|
