|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Senior |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cash Price |
$0.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Senior |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$0.00
|
| Rate for Payer: Heritage Provider Network Senior |
$0.00
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: IEHP Medi-Cal |
$0.02
|
| Rate for Payer: IEHP Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$0.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$0.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SMIC/ID
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.63
|
| Rate for Payer: Heritage Provider Network Senior |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
|
|
HC SMIC/ID
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$67.56 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.56
|
| Rate for Payer: Blue Shield of California Commercial |
$63.11
|
| Rate for Payer: Blue Shield of California EPN |
$49.34
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: IEHP Medi-Cal |
$10.37
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
IP
|
$401.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS OT
|
Facility
OP
|
$401.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103779
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
IP
|
$401.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$300.75 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.48
|
| Rate for Payer: Heritage Provider Network Senior |
$271.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
|
|
HC SMMG CNCRNT APPL IMU SENSORS PT
|
Facility
OP
|
$401.00
|
|
|
Service Code
|
CPT 0778T
|
| Hospital Charge Code |
905103778
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$80.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$214.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$260.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$248.22
|
| Rate for Payer: Heritage Provider Network Senior |
$248.22
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$89.36
|
| Rate for Payer: Heritage Provider Network Senior |
$89.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Blue Shield of California Commercial |
$81.97
|
| Rate for Payer: Blue Shield of California EPN |
$77.48
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$85.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: Dignity Health Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.71
|
| Rate for Payer: Heritage Provider Network Senior |
$81.71
|
| Rate for Payer: Humana Medicare |
$35.85
|
| Rate for Payer: IEHP Medi-Cal |
$31.09
|
| Rate for Payer: IEHP Medicare Advantage |
$35.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.17
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.44
|
| Rate for Payer: TriValley Medical Group Senior |
$35.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$25.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Blue Shield of California Commercial |
$54.65
|
| Rate for Payer: Blue Shield of California EPN |
$51.66
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: Dignity Health Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.47
|
| Rate for Payer: Heritage Provider Network Senior |
$54.47
|
| Rate for Payer: Humana Medicare |
$35.85
|
| Rate for Payer: IEHP Medi-Cal |
$20.86
|
| Rate for Payer: IEHP Medicare Advantage |
$35.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$68.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.17
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.44
|
| Rate for Payer: TriValley Medical Group Senior |
$35.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.46
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.58
|
| Rate for Payer: Heritage Provider Network Senior |
$59.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$109.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$140.09
|
| Rate for Payer: Blue Shield of California EPN |
$109.51
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: IEHP Medi-Cal |
$22.76
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.59
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$109.88 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.88
|
| Rate for Payer: Blue Shield of California Commercial |
$101.57
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.58
|
| Rate for Payer: Heritage Provider Network Senior |
$36.58
|
| Rate for Payer: Humana Medicare |
$13.01
|
| Rate for Payer: IEHP Medi-Cal |
$18.03
|
| Rate for Payer: IEHP Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$44.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.01
|
| Rate for Payer: TriValley Medical Group Senior |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$44.32 |
| Rate for Payer: Adventist Health Commercial |
$11.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.01
|
| Rate for Payer: Heritage Provider Network Senior |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.78
|
| Rate for Payer: Multiplan Commercial |
$44.32
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.63
|
| Rate for Payer: Blue Shield of California Commercial |
$465.75
|
| Rate for Payer: Blue Shield of California EPN |
$440.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$487.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$487.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$464.25
|
| Rate for Payer: Heritage Provider Network Senior |
$464.25
|
| Rate for Payer: Humana Medicare |
$185.20
|
| Rate for Payer: IEHP Medi-Cal |
$288.91
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.35
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$135.75 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$515.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.75
|
| Rate for Payer: Heritage Provider Network Senior |
$507.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$1,972.62 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$255.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,972.62
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.48
|
| Rate for Payer: Dignity Health Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$301.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Humana Medicare |
$301.35
|
| Rate for Payer: IEHP Medi-Cal |
$470.11
|
| Rate for Payer: IEHP Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$572.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.70
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$301.35
|
| Rate for Payer: TriValley Medical Group Senior |
$301.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$325.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$325.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$2,012.18 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,012.18
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$282.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Humana Medicare |
$282.88
|
| Rate for Payer: IEHP Medi-Cal |
$441.29
|
| Rate for Payer: IEHP Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$333.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$356.43
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: TriValley Medical Group Commercial |
$282.88
|
| Rate for Payer: TriValley Medical Group Senior |
$282.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$305.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Gatekeeper |
$109.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Blue Shield of California Commercial |
$654.38
|
| Rate for Payer: Blue Shield of California EPN |
$618.55
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO/PPO |
$684.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Senior |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$652.27
|
| Rate for Payer: Heritage Provider Network Senior |
$652.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$507.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$190.73 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.93
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.39
|
| Rate for Payer: Heritage Provider Network Senior |
$713.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.44
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$119.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$114.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
|
