|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$153.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.84
|
| Rate for Payer: Blue Shield of California Commercial |
$86.46
|
| Rate for Payer: Blue Shield of California EPN |
$69.35
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$144.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Senior |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.04
|
| Rate for Payer: Heritage Provider Network Senior |
$138.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$106.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$167.25 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$122.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.97
|
| Rate for Payer: Heritage Provider Network Senior |
$150.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.75
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.12
|
| Rate for Payer: Blue Shield of California Commercial |
$114.85
|
| Rate for Payer: Blue Shield of California EPN |
$92.12
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.27
|
| Rate for Payer: TriValley Medical Group Senior |
$14.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.85 |
| Max. Negotiated Rate |
$2,415.55 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$510.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$656.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,216.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,415.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,942.51
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$620.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Senior |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$683.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$591.14
|
| Rate for Payer: Heritage Provider Network Senior |
$591.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$634.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$861.75
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$752.32
|
| Rate for Payer: TriValley Medical Group Senior |
$683.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$477.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$477.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.85 |
| Max. Negotiated Rate |
$716.25 |
| Rate for Payer: Adventist Health Commercial |
$191.00
|
| Rate for Payer: Cash Price |
$525.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$646.53
|
| Rate for Payer: Heritage Provider Network Senior |
$646.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.75
|
| Rate for Payer: Multiplan Commercial |
$716.25
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,089.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,600.15
|
| 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 |
$8,189.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| 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 |
$9,923.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,310.39
|
| Rate for Payer: TriValley Medical Group Senior |
$1,310.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,089.70
|
| 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 |
$1,915.00
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,600.15
|
| 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 |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| 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 |
$6,311.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| 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 |
$9,923.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,760.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,380.78
|
| 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 HERNIA REDUCTION
|
Facility
|
IP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,394.81 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$13,231.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,394.81 |
| Max. Negotiated Rate |
$9,923.25 |
| Rate for Payer: Adventist Health Commercial |
$2,646.20
|
| Rate for Payer: Cash Price |
$7,277.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,957.39
|
| Rate for Payer: Heritage Provider Network Senior |
$8,957.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,394.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,307.75
|
| Rate for Payer: Multiplan Commercial |
$9,923.25
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$120.41 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.41
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.62
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.58
|
| Rate for Payer: Blue Shield of California Commercial |
$155.81
|
| Rate for Payer: Blue Shield of California EPN |
$124.97
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.95
|
| Rate for Payer: Heritage Provider Network Senior |
$82.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.35
|
| Rate for Payer: TriValley Medical Group Senior |
$19.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$90.72
|
| Rate for Payer: Heritage Provider Network Senior |
$90.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.06 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$181.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$106.13
|
| Rate for Payer: Blue Shield of California EPN |
$106.13
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Senior |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.23
|
| Rate for Payer: Heritage Provider Network Senior |
$122.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$126.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$106.13
|
| Rate for Payer: Blue Shield of California EPN |
$106.13
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$121.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$122.23
|
| Rate for Payer: Heritage Provider Network Senior |
$122.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$132.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.41
|
|
|
HC HIGH FLOW 02
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$298.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$186.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Blue Shield of California Commercial |
$212.28
|
| Rate for Payer: Blue Shield of California EPN |
$169.82
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.41
|
| Rate for Payer: Heritage Provider Network Senior |
$215.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$166.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$174.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$174.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC HIGH FLOW 02
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.60
|
| Rate for Payer: Heritage Provider Network Senior |
$235.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$676.94 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,531.98
|
| Rate for Payer: Heritage Provider Network Senior |
$2,531.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$2,805.00 |
| Rate for Payer: Adventist Health Commercial |
$748.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,999.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cash Price |
$2,057.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,431.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Senior |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,431.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$839.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,315.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,315.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,783.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$676.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,058.39
|
| Rate for Payer: Multiplan Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$615.40 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,301.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,301.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Adventist Health Commercial |
$680.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,817.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,335.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Senior |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$839.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,104.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,104.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$615.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$850.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,058.39
|
| Rate for Payer: Multiplan Commercial |
$2,550.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$376.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.83 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Adventist Health Commercial |
$130.20
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.73
|
| Rate for Payer: Heritage Provider Network Senior |
$440.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.75
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
|
