|
HC SODIUM
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900910269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC SODIUM BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM BODY FLUID
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900912246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
OP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,588.65 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.10
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: Dignity Health Senior |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,196.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$865.35
|
| Rate for Payer: Heritage Provider Network Senior |
$865.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$900.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$747.60
|
| Rate for Payer: TriValley Medical Group Senior |
$747.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$681.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$624.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC SODIUM FLUORIDE F-18 UP TO 30
|
Facility
|
IP
|
$1,869.00
|
|
|
Service Code
|
CPT A9580
|
| Hospital Charge Code |
909301573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.29 |
| Max. Negotiated Rate |
$1,401.75 |
| Rate for Payer: Adventist Health Commercial |
$373.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,284.00
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,009.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,265.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,265.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$681.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$624.43
|
|
|
HC SODIUM STOOL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$40.52 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.52
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.35
|
| Rate for Payer: Dignity Health Senior |
$4.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.12
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.86
|
| Rate for Payer: TriValley Medical Group Senior |
$4.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4.86
|
|
|
HC SODIUM STOOL
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
900910418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900910270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SODIUM URINE 24 HOURS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SODIUM URINE 24 HOURS
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SODIUM URINE RANDOM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$40.69 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.69
|
| Rate for Payer: Blue Shield of California Commercial |
$37.96
|
| Rate for Payer: Blue Shield of California EPN |
$29.67
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.57
|
| Rate for Payer: Dignity Health Senior |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$5.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.06
|
| Rate for Payer: TriValley Medical Group Senior |
$5.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.57
|
| Rate for Payer: Vantage Medical Group Senior |
$5.06
|
|
|
HC SODIUM URINE RANDOM
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
900912220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.82
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.76
|
| Rate for Payer: Heritage Provider Network Senior |
$71.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
|
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.47
|
| Rate for Payer: Blue Shield of California EPN |
$80.89
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.26
|
| Rate for Payer: Heritage Provider Network Senior |
$40.26
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF 60735 MYCOP IGG 86738
|
Facility
|
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.03
|
| Rate for Payer: Heritage Provider Network Senior |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
|
OP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$110.39 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.39
|
| Rate for Payer: Blue Shield of California Commercial |
$103.47
|
| Rate for Payer: Blue Shield of California EPN |
$80.89
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.26
|
| Rate for Payer: Heritage Provider Network Senior |
$40.26
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.68
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOF 60735 MYCOP IGM 86738
|
Facility
|
IP
|
$65.04
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
900914878
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$48.78 |
| Rate for Payer: Adventist Health Commercial |
$13.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$44.68
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.03
|
| Rate for Payer: Heritage Provider Network Senior |
$44.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$48.78
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.56
|
| Rate for Payer: Blue Shield of California Commercial |
$334.56
|
| Rate for Payer: Blue Shield of California EPN |
$261.54
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$226.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$216.03
|
| Rate for Payer: Heritage Provider Network Senior |
$216.03
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.98
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$42.84
|
| Rate for Payer: TriValley Medical Group Senior |
$42.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$46.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOF ADENOVIRUS DNA QUANT PCR
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912932
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Adventist Health Commercial |
$69.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$239.76
|
| Rate for Payer: Cash Price |
$157.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.27
|
| Rate for Payer: Heritage Provider Network Senior |
$236.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.25
|
| Rate for Payer: Multiplan Commercial |
$261.75
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF INFLUENZA TYPE A AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$105.87
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Humana Medicare |
$13.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
IP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$40.73 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.77
|
| Rate for Payer: Heritage Provider Network Senior |
$36.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
|
|
HC SOF INFLUENZA TYPE B AB
|
Facility
|
OP
|
$54.31
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900914695
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$115.63 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.63
|
| Rate for Payer: Blue Shield of California Commercial |
$105.87
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Senior |
$13.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.62
|
| Rate for Payer: Heritage Provider Network Senior |
$33.62
|
| Rate for Payer: Humana Medicare |
$13.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.07
|
| Rate for Payer: Multiplan Commercial |
$40.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.55
|
| Rate for Payer: TriValley Medical Group Senior |
$13.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOF NOROVIRUS RNA
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care 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 |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| 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 |
$193.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| 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 |
$223.50
|
| 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 SOF NOROVIRUS RNA
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914720
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$201.75
|
| Rate for Payer: Heritage Provider Network Senior |
$201.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
|
