|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.27
|
| Rate for Payer: Heritage Provider Network Senior |
$83.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$105.35 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$65.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$84.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.14
|
| Rate for Payer: Heritage Provider Network Senior |
$76.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.49
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Senior |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Senior |
$219.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$189.20
|
| Rate for Payer: TriValley Medical Group Senior |
$189.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Senior |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.61
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$264.62 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$804.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$989.77
|
| Rate for Payer: Heritage Provider Network Senior |
$989.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.50
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$255.83 |
| Max. Negotiated Rate |
$1,143.33 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$781.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,004.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,143.33
|
| Rate for Payer: Blue Shield of California Commercial |
$897.70
|
| Rate for Payer: Blue Shield of California EPN |
$721.90
|
| Rate for Payer: Cash Price |
$804.10
|
| Rate for Payer: Cash Price |
$804.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$904.98
|
| Rate for Payer: Heritage Provider Network Senior |
$904.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$255.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$697.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$731.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
IP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,226.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.51
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,183.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,183.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$923.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$846.29
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,226.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,755.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.51
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cash Price |
$1,405.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,172.60
|
| Rate for Payer: Dignity Health Senior |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,635.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,183.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,183.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,789.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,789.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$923.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$846.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.92
|
| Rate for Payer: Blue Shield of California Commercial |
$142.85
|
| Rate for Payer: Blue Shield of California EPN |
$114.87
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$304.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$481.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$618.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$489.61
|
| Rate for Payer: Blue Shield of California Commercial |
$260.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.10
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$585.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$557.10
|
| Rate for Payer: Heritage Provider Network Senior |
$557.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI 2 OR 3 VIEWS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 72082
|
| Hospital Charge Code |
909072082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.90 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$180.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.30
|
| Rate for Payer: Heritage Provider Network Senior |
$609.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$675.00
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$1,098.75 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$783.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,006.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.53
|
| Rate for Payer: Blue Shield of California Commercial |
$282.19
|
| Rate for Payer: Blue Shield of California EPN |
$226.93
|
| Rate for Payer: Cash Price |
$805.75
|
| Rate for Payer: Cash Price |
$805.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$906.84
|
| Rate for Payer: Heritage Provider Network Senior |
$906.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$698.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,098.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY ENTIRE SPI 4 OR 5 VIEWS
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
CPT 72083
|
| Hospital Charge Code |
909072083
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.17 |
| Max. Negotiated Rate |
$1,098.75 |
| Rate for Payer: Adventist Health Commercial |
$293.00
|
| Rate for Payer: Cash Price |
$805.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$991.80
|
| Rate for Payer: Heritage Provider Network Senior |
$991.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.25
|
| Rate for Payer: Multiplan Commercial |
$1,098.75
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.32 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$1,003.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,235.53
|
| Rate for Payer: Heritage Provider Network Senior |
$1,235.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
|
|
HC XRAY ENTIRE SPI MIN 6 VIEWS
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT 72084
|
| Hospital Charge Code |
909072084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.44 |
| Max. Negotiated Rate |
$1,368.75 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$975.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,253.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.99
|
| Rate for Payer: Blue Shield of California Commercial |
$338.78
|
| Rate for Payer: Blue Shield of California EPN |
$272.44
|
| Rate for Payer: Cash Price |
$1,003.75
|
| Rate for Payer: Cash Price |
$1,003.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,186.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,129.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,129.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$870.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,368.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$307.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$236.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.38
|
| Rate for Payer: Blue Shield of California Commercial |
$108.48
|
| Rate for Payer: Blue Shield of California EPN |
$87.24
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$287.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Senior |
$273.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$210.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY FEMUR 1 VIEW
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
909073551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$299.23
|
| Rate for Payer: Heritage Provider Network Senior |
$299.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.50
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$443.44
|
| Rate for Payer: Heritage Provider Network Senior |
$443.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
|
|
HC XRAY FEMUR MIN 2 VIEWS
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
909073552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.22 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$350.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.73
|
| Rate for Payer: Blue Shield of California Commercial |
$128.69
|
| Rate for Payer: Blue Shield of California EPN |
$103.49
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.44
|
| Rate for Payer: Heritage Provider Network Senior |
$405.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$312.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$522.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$671.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.46
|
| Rate for Payer: Blue Shield of California Commercial |
$158.98
|
| Rate for Payer: Blue Shield of California EPN |
$127.84
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$635.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$635.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$605.38
|
| Rate for Payer: Heritage Provider Network Senior |
$605.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$466.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 2 VIEWS
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
909073521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.11
|
| Rate for Payer: Heritage Provider Network Senior |
$662.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.50
|
| Rate for Payer: Multiplan Commercial |
$733.50
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
OP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$772.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$993.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.12
|
| Rate for Payer: Blue Shield of California Commercial |
$189.31
|
| Rate for Payer: Blue Shield of California EPN |
$152.24
|
| Rate for Payer: Cash Price |
$795.30
|
| Rate for Payer: Cash Price |
$795.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$939.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$939.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$895.07
|
| Rate for Payer: Heritage Provider Network Senior |
$895.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$689.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$161.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$161.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC XRAY HIP W/PELVIS BI 3-4 VIEWS
|
Facility
|
IP
|
$1,446.00
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
909073522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Cash Price |
$795.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$978.94
|
| Rate for Payer: Heritage Provider Network Senior |
$978.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
|
|
HC XRAY HIP W/PELVIS BI 5/GT VIEWS
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
909073523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.94 |
| Max. Negotiated Rate |
$1,139.25 |
| Rate for Payer: Adventist Health Commercial |
$303.80
|
| Rate for Payer: Cash Price |
$835.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,028.36
|
| Rate for Payer: Heritage Provider Network Senior |
$1,028.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$379.75
|
| Rate for Payer: Multiplan Commercial |
$1,139.25
|
|
