|
HC LAB REF HERPESVIRUS 6 AB IGG
|
Facility
OP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900910749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.86
|
| Rate for Payer: Heritage Provider Network Senior |
$30.86
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.86
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF HERPESVIRUS 6 AB, IGM
|
Facility
OP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.86
|
| Rate for Payer: Blue Shield of California Commercial |
$100.62
|
| Rate for Payer: Blue Shield of California EPN |
$78.66
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.41
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.86
|
| Rate for Payer: Heritage Provider Network Senior |
$30.86
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: IEHP Medi-Cal |
$17.86
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC LAB REF HERPESVIRUS 6 AB, IGM
|
Facility
IP
|
$49.86
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$37.40 |
| Rate for Payer: Adventist Health Commercial |
$9.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.25
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.76
|
| Rate for Payer: Heritage Provider Network Senior |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$37.40
|
|
|
HC LAB REF HIV 1
|
Facility
OP
|
$21.40
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900910666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.01
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Heritage Provider Network Senior |
$13.25
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: IEHP Medi-Cal |
$26.83
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| 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 |
$16.05
|
| 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 |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HIV 1
|
Facility
IP
|
$21.40
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900910666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.70
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.49
|
| Rate for Payer: Heritage Provider Network Senior |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$16.05
|
|
|
HC LAB REF HIV 1/2 CONFIRM. EVAL
|
Facility
OP
|
$27.72
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Adventist Health Commercial |
$5.54
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.01
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.16
|
| Rate for Payer: Heritage Provider Network Senior |
$17.16
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: IEHP Medi-Cal |
$26.83
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| 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 |
$20.79
|
| 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 |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HIV 1/2 CONFIRM. EVAL
|
Facility
IP
|
$27.72
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
900912813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Adventist Health Commercial |
$5.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.04
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.77
|
| Rate for Payer: Heritage Provider Network Senior |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
|
|
HC LAB REF HPA ANTIBODIES
|
Facility
OP
|
$26.31
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900911214
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.45
|
| Rate for Payer: Blue Shield of California Commercial |
$143.44
|
| Rate for Payer: Blue Shield of California EPN |
$112.13
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.29
|
| Rate for Payer: Heritage Provider Network Senior |
$16.29
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: IEHP Medi-Cal |
$25.47
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| Rate for Payer: Multiplan Commercial |
$19.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC LAB REF HPA ANTIBODIES
|
Facility
IP
|
$26.31
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900911214
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.07
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.81
|
| Rate for Payer: Heritage Provider Network Senior |
$17.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$19.73
|
|
|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
IP
|
$106.50
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$79.88 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.17
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.10
|
| Rate for Payer: Heritage Provider Network Senior |
$72.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.62
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
|
|
HC LAB REF HSV 1/2 IGM CSF
|
Facility
OP
|
$106.50
|
|
| Hospital Charge Code |
900911351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$90.52 |
| Rate for Payer: Adventist Health Commercial |
$21.30
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$90.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$58.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$79.88
|
| Rate for Payer: Blue Shield of California Commercial |
$66.14
|
| Rate for Payer: Blue Shield of California EPN |
$62.52
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$69.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.52
|
| Rate for Payer: Dignity Health Senior |
$90.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.92
|
| Rate for Payer: Heritage Provider Network Senior |
$65.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.62
|
| Rate for Payer: Multiplan Commercial |
$79.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.52
|
| Rate for Payer: Vantage Medical Group Senior |
$90.52
|
|
|
HC LAB REF HSV 1 IGG
|
Facility
IP
|
$14.05
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900911468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
|
|
HC LAB REF HSV 1 IGG
|
Facility
OP
|
$14.05
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900911468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.02
|
| Rate for Payer: Blue Shield of California EPN |
$80.54
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Senior |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8.70
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: IEHP Medi-Cal |
$18.28
|
| Rate for Payer: IEHP Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| 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 |
$10.54
|
| 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 |
$19.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF HSV 2 IGG
|
Facility
OP
|
$14.05
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900911469
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$161.90 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.90
|
| Rate for Payer: Blue Shield of California Commercial |
$151.21
|
| Rate for Payer: Blue Shield of California EPN |
$118.21
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.28
|
| Rate for Payer: Dignity Health Senior |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.70
|
| Rate for Payer: Heritage Provider Network Senior |
$8.70
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: IEHP Medi-Cal |
$26.83
|
| Rate for Payer: IEHP Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$36.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| 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 |
$10.54
|
| 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 |
$21.28
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC LAB REF HSV 2 IGG
|
Facility
IP
|
$14.05
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900911469
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$10.54 |
| Rate for Payer: Adventist Health Commercial |
$2.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.65
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$10.54
|
|
|
HC LAB REF HSV PCR
|
Facility
OP
|
$194.44
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900910770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$38.89
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$126.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$120.36
|
| Rate for Payer: Heritage Provider Network Senior |
$120.36
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: IEHP Medi-Cal |
$38.31
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.21
|
| Rate for Payer: Multiplan Commercial |
$145.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.09
|
| Rate for Payer: TriValley Medical Group Senior |
$35.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$37.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$37.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LAB REF HSV PCR
|
Facility
IP
|
$194.44
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900910770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.19 |
| Max. Negotiated Rate |
$145.83 |
| Rate for Payer: Adventist Health Commercial |
$38.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$133.58
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$131.64
|
| Rate for Payer: Heritage Provider Network Senior |
$131.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.61
|
| Rate for Payer: Multiplan Commercial |
$145.83
|
|
|
HC LAB REF HYDROMORPHONE
|
Facility
OP
|
$229.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Senior |
$194.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$141.75
|
| Rate for Payer: Heritage Provider Network Senior |
$141.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC LAB REF HYDROMORPHONE
|
Facility
IP
|
$229.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$171.75 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.32
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$155.03
|
| Rate for Payer: Heritage Provider Network Senior |
$155.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.25
|
| Rate for Payer: Multiplan Commercial |
$171.75
|
|
|
HC LAB REF IGF-BP2
|
Facility
OP
|
$59.91
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$11.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$26.96
|
| Rate for Payer: Cash Price |
$26.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.08
|
| Rate for Payer: Heritage Provider Network Senior |
$37.08
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC LAB REF IGF-BP2
|
Facility
IP
|
$59.91
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Adventist Health Commercial |
$11.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.16
|
| Rate for Payer: Cash Price |
$26.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.56
|
| Rate for Payer: Heritage Provider Network Senior |
$40.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.98
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
IP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$54.14 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.87
|
| Rate for Payer: Heritage Provider Network Senior |
$48.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.04
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
|
|
HC LAB REF IMMUNE COMPLEX PANEL C3D
|
Facility
OP
|
$72.18
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900912837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$203.99 |
| Rate for Payer: Adventist Health Commercial |
$14.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$70.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$190.34
|
| Rate for Payer: Blue Shield of California EPN |
$148.80
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cash Price |
$32.48
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Senior |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Humana Medicare |
$24.37
|
| Rate for Payer: IEHP Medi-Cal |
$33.79
|
| Rate for Payer: IEHP Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$46.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.71
|
| Rate for Payer: Multiplan Commercial |
$54.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.37
|
| Rate for Payer: TriValley Medical Group Senior |
$24.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$186.97 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.97
|
| Rate for Payer: Blue Shield of California Commercial |
$174.46
|
| Rate for Payer: Blue Shield of California EPN |
$136.39
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$104.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: Dignity Health Senior |
$22.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$99.04
|
| Rate for Payer: Heritage Provider Network Senior |
$99.04
|
| Rate for Payer: Humana Medicare |
$22.34
|
| Rate for Payer: IEHP Medi-Cal |
$30.98
|
| Rate for Payer: IEHP Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.15
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.34
|
| Rate for Payer: TriValley Medical Group Senior |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC LAB REF IMMUNO FIXATION ELECTROPHORESI
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900912722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$109.92
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
|
