|
HC HEPATITIS B CORE AB IGM
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913615
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.98
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.66
|
| Rate for Payer: Heritage Provider Network Senior |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
IP
|
$291.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.92
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.01
|
| Rate for Payer: Heritage Provider Network Senior |
$197.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
|
|
HC HEPATITIS B CORE AB IGM INDIVIDUAL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900913618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$95.35 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.35
|
| Rate for Payer: Blue Shield of California Commercial |
$91.90
|
| Rate for Payer: Blue Shield of California EPN |
$71.84
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: IEHP Medi-Cal |
$16.18
|
| Rate for Payer: IEHP Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$95.35 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.35
|
| Rate for Payer: Blue Shield of California Commercial |
$91.90
|
| Rate for Payer: Blue Shield of California EPN |
$71.84
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: IEHP Medi-Cal |
$16.18
|
| Rate for Payer: IEHP Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900910958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$95.35 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.35
|
| Rate for Payer: Blue Shield of California Commercial |
$91.90
|
| Rate for Payer: Blue Shield of California EPN |
$71.84
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.95
|
| Rate for Payer: Dignity Health Senior |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: IEHP Medi-Cal |
$16.18
|
| Rate for Payer: IEHP Medicare Advantage |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.83
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Senior |
$11.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$11.77
|
|
|
HC HEPATITIS B CORE IGM INDIVIDUAL
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
900912336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$197.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC HEPATITIS BE AB
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$93.32 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.32
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$70.36
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.24
|
| Rate for Payer: Heritage Provider Network Senior |
$27.24
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC HEPATITIS BE AB
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
900913616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.91
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.30
|
| Rate for Payer: Heritage Provider Network Senior |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.25
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$80.66
|
| Rate for Payer: Blue Shield of California EPN |
$63.06
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$10.33
|
| Rate for Payer: IEHP Medi-Cal |
$14.23
|
| Rate for Payer: IEHP Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900910831
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$86.39 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.39
|
| Rate for Payer: Blue Shield of California Commercial |
$80.66
|
| Rate for Payer: Blue Shield of California EPN |
$63.06
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.14
|
| Rate for Payer: Heritage Provider Network Senior |
$24.14
|
| Rate for Payer: Humana Medicare |
$10.33
|
| Rate for Payer: IEHP Medi-Cal |
$14.32
|
| Rate for Payer: IEHP Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE AG (CONF)
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
900910812
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$148.39
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$146.23
|
| Rate for Payer: Heritage Provider Network Senior |
$146.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$95.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
|
|
HC HEPATITIS B SURFACE AG INDIVIDUAL
|
Facility
OP
|
$36.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
900912333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$30.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$24.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.62
|
| Rate for Payer: Blue Shield of California Commercial |
$80.66
|
| Rate for Payer: Blue Shield of California EPN |
$63.06
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$23.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: Dignity Health Senior |
$10.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.28
|
| Rate for Payer: Heritage Provider Network Senior |
$22.28
|
| Rate for Payer: Humana Medicare |
$10.33
|
| Rate for Payer: IEHP Medi-Cal |
$14.23
|
| Rate for Payer: IEHP Medicare Advantage |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.02
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$10.33
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$114.41
|
| Rate for Payer: Heritage Provider Network Senior |
$114.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.25
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
900910860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$31.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.95
|
| Rate for Payer: Blue Shield of California Commercial |
$83.91
|
| Rate for Payer: Blue Shield of California EPN |
$65.59
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20.15
|
| 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 |
$20.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.19
|
| Rate for Payer: Heritage Provider Network Senior |
$19.19
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: IEHP Medi-Cal |
$14.84
|
| Rate for Payer: IEHP Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| 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 |
$23.25
|
| 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 C AB TOTAL
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$111.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.14
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$14.27
|
| Rate for Payer: IEHP Medi-Cal |
$19.61
|
| Rate for Payer: IEHP Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| 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 |
$39.75
|
| 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 |
$21.40
|
| 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
|
$277.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$207.75 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.30
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.53
|
| Rate for Payer: Heritage Provider Network Senior |
$187.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.25
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
IP
|
$277.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$207.75 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.30
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.53
|
| Rate for Payer: Heritage Provider Network Senior |
$187.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.25
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
|
|
HC HEPATITIS C AB TOTAL INDIVIDUAL
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
900912156
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$111.46
|
| Rate for Payer: Blue Shield of California EPN |
$87.14
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.70
|
| Rate for Payer: Dignity Health Senior |
$14.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32.81
|
| Rate for Payer: Humana Medicare |
$14.27
|
| Rate for Payer: IEHP Medi-Cal |
$19.61
|
| Rate for Payer: IEHP Medicare Advantage |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.25
|
| 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 |
$39.75
|
| 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 |
$21.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.27
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$2,345.10 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$912.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,032.47
|
| Rate for Payer: Blue Shield of California Commercial |
$2,345.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,333.59
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$768.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$768.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.66
|
| Rate for Payer: Heritage Provider Network Senior |
$731.66
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$611.41
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC HEPATOBIL SYST IMAGE W DRUG
|
Facility
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
909301227
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$886.50 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.21
|
| Rate for Payer: Heritage Provider Network Senior |
$800.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
|
|
HC HERNIA REDUCTION
|
Facility
OP
|
$10,004.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,872.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,502.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,772.71
|
| Rate for Payer: Heritage Provider Network Senior |
$6,772.71
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,821.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,501.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$7,503.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,632.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,342.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC HERNIA REDUCTION
|
Facility
IP
|
$10,004.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,810.72 |
| Max. Negotiated Rate |
$7,503.00 |
| Rate for Payer: Adventist Health Commercial |
$2,000.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,872.75
|
| Rate for Payer: Cash Price |
$4,501.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,772.71
|
| Rate for Payer: Heritage Provider Network Senior |
$6,772.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,501.00
|
| Rate for Payer: Multiplan Commercial |
$7,503.00
|
|
