|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
OP
|
$6,608.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906811487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$13,496.00 |
| Rate for Payer: Adventist Health Commercial |
$1,321.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,539.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,616.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,634.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,956.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,295.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,616.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,616.80
|
| Rate for Payer: Dignity Health Senior |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,090.35
|
| Rate for Payer: Heritage Provider Network Senior |
$4,090.35
|
| Rate for Payer: IEHP Medi-Cal |
$2,487.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,185.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,196.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.00
|
| Rate for Payer: Multiplan Commercial |
$4,956.00
|
| 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 Medi-Cal |
$5,616.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,616.80
|
|
|
HC TRANSCATH MITRAL VALVE REPAIR
|
Facility
OP
|
$82,271.00
|
|
|
Service Code
|
CPT 33418
|
| Hospital Charge Code |
906820021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$69,930.35 |
| Rate for Payer: Adventist Health Commercial |
$16,454.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56,520.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69,930.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45,249.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$61,703.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cash Price |
$37,021.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53,476.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69,930.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$69,930.35
|
| Rate for Payer: Dignity Health Senior |
$69,930.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50,925.75
|
| Rate for Payer: Heritage Provider Network Senior |
$50,925.75
|
| Rate for Payer: IEHP Medi-Cal |
$2,487.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39,654.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,891.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,567.75
|
| Rate for Payer: Multiplan Commercial |
$61,703.25
|
| 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 Medi-Cal |
$69,930.35
|
| Rate for Payer: Vantage Medical Group Senior |
$69,930.35
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906820204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,146.42 |
| Max. Negotiated Rate |
$58,617.75 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,912.29
|
| Rate for Payer: Heritage Provider Network Senior |
$52,912.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906820204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$35,170.65
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,802.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Senior |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,379.18
|
| Rate for Payer: Heritage Provider Network Senior |
$48,379.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37,671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
| 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 Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
OP
|
$66,294.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906800483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$56,349.90 |
| Rate for Payer: Adventist Health Commercial |
$13,258.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45,543.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56,349.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36,461.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49,720.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$29,832.30
|
| Rate for Payer: Cash Price |
$29,832.30
|
| Rate for Payer: Cash Price |
$29,832.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43,091.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56,349.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$56,349.90
|
| Rate for Payer: Dignity Health Senior |
$56,349.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$41,035.99
|
| Rate for Payer: Heritage Provider Network Senior |
$41,035.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,953.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,573.50
|
| Rate for Payer: Multiplan Commercial |
$49,720.50
|
| 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 Medi-Cal |
$56,349.90
|
| Rate for Payer: Vantage Medical Group Senior |
$56,349.90
|
|
|
HC TRANSCATH MITRAL VLVE IMPL/REP
|
Facility
IP
|
$66,294.00
|
|
|
Service Code
|
CPT 0483T
|
| Hospital Charge Code |
906800483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,999.21 |
| Max. Negotiated Rate |
$49,720.50 |
| Rate for Payer: Adventist Health Commercial |
$13,258.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45,543.98
|
| Rate for Payer: Cash Price |
$29,832.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44,881.04
|
| Rate for Payer: Heritage Provider Network Senior |
$44,881.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,573.50
|
| Rate for Payer: Multiplan Commercial |
$49,720.50
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
OP
|
$11,164.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906811479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.92 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,669.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,489.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,140.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,373.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,256.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,489.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,489.40
|
| Rate for Payer: Dignity Health Senior |
$9,489.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,910.52
|
| Rate for Payer: Heritage Provider Network Senior |
$6,910.52
|
| Rate for Payer: IEHP Medi-Cal |
$56.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,381.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,020.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,791.00
|
| Rate for Payer: Multiplan Commercial |
$8,373.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,489.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,489.40
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
OP
|
$14,043.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906820010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.92 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,647.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,936.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,723.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,532.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,319.35
|
| Rate for Payer: Cash Price |
$6,319.35
|
| Rate for Payer: Cash Price |
$6,319.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,127.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,936.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,936.55
|
| Rate for Payer: Dignity Health Senior |
$11,936.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,692.62
|
| Rate for Payer: Heritage Provider Network Senior |
$8,692.62
|
| Rate for Payer: IEHP Medi-Cal |
$56.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,768.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,541.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,510.75
|
| Rate for Payer: Multiplan Commercial |
$10,532.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,936.55
|
| Rate for Payer: Vantage Medical Group Senior |
$11,936.55
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
IP
|
$11,164.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906811479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,020.68 |
| Max. Negotiated Rate |
$8,373.00 |
| Rate for Payer: Adventist Health Commercial |
$2,232.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,669.67
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,558.03
|
| Rate for Payer: Heritage Provider Network Senior |
$7,558.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,020.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,791.00
|
| Rate for Payer: Multiplan Commercial |
$8,373.00
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC ADDL ART
|
Facility
IP
|
$14,043.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
906820010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,541.78 |
| Max. Negotiated Rate |
$10,532.25 |
| Rate for Payer: Adventist Health Commercial |
$2,808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,647.54
|
| Rate for Payer: Cash Price |
$6,319.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,507.11
|
| Rate for Payer: Heritage Provider Network Senior |
$9,507.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,541.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,510.75
|
| Rate for Payer: Multiplan Commercial |
$10,532.25
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
IP
|
$11,164.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906811481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,020.68 |
| Max. Negotiated Rate |
$8,373.00 |
| Rate for Payer: Adventist Health Commercial |
$2,232.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,669.67
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,558.03
|
| Rate for Payer: Heritage Provider Network Senior |
$7,558.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,020.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,791.00
|
| Rate for Payer: Multiplan Commercial |
$8,373.00
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
IP
|
$13,342.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906820012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,414.90 |
| Max. Negotiated Rate |
$10,006.50 |
| Rate for Payer: Adventist Health Commercial |
$2,668.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,165.95
|
| Rate for Payer: Cash Price |
$6,003.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,032.53
|
| Rate for Payer: Heritage Provider Network Senior |
$9,032.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,335.50
|
| Rate for Payer: Multiplan Commercial |
$10,006.50
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
OP
|
$13,342.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906820012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,668.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,165.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,340.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,338.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,006.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$6,003.90
|
| Rate for Payer: Cash Price |
$6,003.90
|
| Rate for Payer: Cash Price |
$6,003.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,672.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,340.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,340.70
|
| Rate for Payer: Dignity Health Senior |
$11,340.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,258.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8,258.70
|
| Rate for Payer: IEHP Medi-Cal |
$39.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,430.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,335.50
|
| Rate for Payer: Multiplan Commercial |
$10,006.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,340.70
|
| Rate for Payer: Vantage Medical Group Senior |
$11,340.70
|
|
|
HC TRANSCATH PLCMT INT STNT OPENPERC ADDL VEIN
|
Facility
OP
|
$11,164.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
906811481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,232.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,669.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,489.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,140.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,373.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cash Price |
$5,023.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,256.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,489.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,489.40
|
| Rate for Payer: Dignity Health Senior |
$9,489.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,910.52
|
| Rate for Payer: Heritage Provider Network Senior |
$6,910.52
|
| Rate for Payer: IEHP Medi-Cal |
$39.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,381.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,020.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,791.00
|
| Rate for Payer: Multiplan Commercial |
$8,373.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,489.40
|
| Rate for Payer: Vantage Medical Group Senior |
$9,489.40
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
IP
|
$34,629.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,267.85 |
| Max. Negotiated Rate |
$25,971.75 |
| Rate for Payer: Adventist Health Commercial |
$6,925.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,790.12
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,443.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23,443.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,267.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,657.25
|
| Rate for Payer: Multiplan Commercial |
$25,971.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
OP
|
$34,629.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906811478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.14 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,925.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,790.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,508.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,435.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$612.14
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,267.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,657.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$25,971.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
OP
|
$30,489.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906820009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$612.14 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,097.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,945.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$13,720.05
|
| Rate for Payer: Cash Price |
$13,720.05
|
| Rate for Payer: Cash Price |
$13,720.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,817.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,872.69
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$612.14
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,518.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,622.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$22,866.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT ART
|
Facility
IP
|
$30,489.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
906820009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,518.51 |
| Max. Negotiated Rate |
$22,866.75 |
| Rate for Payer: Adventist Health Commercial |
$6,097.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,945.94
|
| Rate for Payer: Cash Price |
$13,720.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,641.05
|
| Rate for Payer: Heritage Provider Network Senior |
$20,641.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,518.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,622.25
|
| Rate for Payer: Multiplan Commercial |
$22,866.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
OP
|
$27,586.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906820011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$5,517.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,951.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$12,413.70
|
| Rate for Payer: Cash Price |
$12,413.70
|
| Rate for Payer: Cash Price |
$12,413.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,930.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,075.73
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$429.20
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,993.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,896.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$20,689.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
IP
|
$27,586.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906820011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,993.07 |
| Max. Negotiated Rate |
$20,689.50 |
| Rate for Payer: Adventist Health Commercial |
$5,517.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,951.58
|
| Rate for Payer: Cash Price |
$12,413.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,675.72
|
| Rate for Payer: Heritage Provider Network Senior |
$18,675.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,993.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,896.50
|
| Rate for Payer: Multiplan Commercial |
$20,689.50
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
IP
|
$34,629.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,267.85 |
| Max. Negotiated Rate |
$25,971.75 |
| Rate for Payer: Adventist Health Commercial |
$6,925.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,790.12
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,443.83
|
| Rate for Payer: Heritage Provider Network Senior |
$23,443.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,267.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,657.25
|
| Rate for Payer: Multiplan Commercial |
$25,971.75
|
|
|
HC TRANSCATH PLCMT INT STNT OPEN PERC INIT VEIN
|
Facility
OP
|
$34,629.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
906811480
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,925.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$23,790.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cash Price |
$15,583.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,508.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,435.35
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: IEHP Medi-Cal |
$429.20
|
| Rate for Payer: IEHP Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,267.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,657.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$25,971.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$933.56 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,802.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Senior |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,379.18
|
| Rate for Payer: Heritage Provider Network Senior |
$48,379.18
|
| Rate for Payer: IEHP Medi-Cal |
$1,741.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$37,671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
| 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 Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC TRANSCATH PULM VALVE IMPLANT
|
Facility
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 33477
|
| Hospital Charge Code |
906820256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,146.42 |
| Max. Negotiated Rate |
$58,617.75 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,693.86
|
| Rate for Payer: Cash Price |
$35,170.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,912.29
|
| Rate for Payer: Heritage Provider Network Senior |
$52,912.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,146.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,539.25
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
|
|
HC TRANSCATH RENAL DENERVATION
|
Facility
IP
|
$12,334.00
|
|
|
Service Code
|
CPT 0338T
|
| Hospital Charge Code |
906820002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,232.45 |
| Max. Negotiated Rate |
$9,250.50 |
| Rate for Payer: Adventist Health Commercial |
$2,466.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,473.46
|
| Rate for Payer: Cash Price |
$5,550.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,350.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8,350.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,232.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,083.50
|
| Rate for Payer: Multiplan Commercial |
$9,250.50
|
|
