|
HC SOM CA 27.29
|
Facility
OP
|
$14.75
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.07
|
| Rate for Payer: Blue Shield of California Commercial |
$162.50
|
| Rate for Payer: Blue Shield of California EPN |
$127.04
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Heritage Provider Network Senior |
$9.13
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: IEHP Medi-Cal |
$28.86
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.81
|
| Rate for Payer: TriValley Medical Group Senior |
$20.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CA 27.29
|
Facility
IP
|
$14.75
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.13
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.99
|
| Rate for Payer: Heritage Provider Network Senior |
$9.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.69
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.31
|
| Rate for Payer: Heritage Provider Network Senior |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$193.62 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.62
|
| Rate for Payer: Blue Shield of California Commercial |
$180.72
|
| Rate for Payer: Blue Shield of California EPN |
$141.28
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Senior |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.57
|
| Rate for Payer: Heritage Provider Network Senior |
$18.57
|
| Rate for Payer: Humana Medicare |
$23.64
|
| Rate for Payer: IEHP Medi-Cal |
$32.09
|
| Rate for Payer: IEHP Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$44.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$23.64
|
| Rate for Payer: TriValley Medical Group Senior |
$23.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
IP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.87
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.10
|
| Rate for Payer: Heritage Provider Network Senior |
$52.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
OP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$244.96 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.96
|
| Rate for Payer: Blue Shield of California Commercial |
$228.63
|
| Rate for Payer: Blue Shield of California EPN |
$178.73
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.64
|
| Rate for Payer: Heritage Provider Network Senior |
$47.64
|
| Rate for Payer: Humana Medicare |
$29.28
|
| Rate for Payer: IEHP Medi-Cal |
$40.59
|
| Rate for Payer: IEHP Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.89
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
OP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$227.38 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.38
|
| Rate for Payer: Blue Shield of California Commercial |
$212.14
|
| Rate for Payer: Blue Shield of California EPN |
$165.84
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Senior |
$27.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Senior |
$44.20
|
| Rate for Payer: Humana Medicare |
$27.17
|
| Rate for Payer: IEHP Medi-Cal |
$37.33
|
| Rate for Payer: IEHP Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.23
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.17
|
| Rate for Payer: TriValley Medical Group Senior |
$27.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
IP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$53.56 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.06
|
| Rate for Payer: Cash Price |
$32.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.34
|
| Rate for Payer: Heritage Provider Network Senior |
$48.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
IP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$44.96 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.19
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.59
|
| Rate for Payer: Heritage Provider Network Senior |
$40.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
OP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$191.03 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA Gatekeeper |
$66.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.03
|
| Rate for Payer: Blue Shield of California Commercial |
$178.27
|
| Rate for Payer: Blue Shield of California EPN |
$139.36
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cigna of CA HMO/PPO |
$38.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Senior |
$22.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.11
|
| Rate for Payer: Heritage Provider Network Senior |
$37.11
|
| Rate for Payer: Humana Medicare |
$22.81
|
| Rate for Payer: IEHP Medi-Cal |
$31.64
|
| Rate for Payer: IEHP Medicare Advantage |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.74
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.81
|
| Rate for Payer: TriValley Medical Group Senior |
$22.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$24.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.81
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
OP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$244.96 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.96
|
| Rate for Payer: Blue Shield of California Commercial |
$228.63
|
| Rate for Payer: Blue Shield of California EPN |
$178.73
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.63
|
| Rate for Payer: Heritage Provider Network Senior |
$47.63
|
| Rate for Payer: Humana Medicare |
$29.28
|
| Rate for Payer: IEHP Medi-Cal |
$40.59
|
| Rate for Payer: IEHP Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$55.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.89
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
IP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$57.71 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.86
|
| Rate for Payer: Cash Price |
$34.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.10
|
| Rate for Payer: Heritage Provider Network Senior |
$52.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
|
|
HC SOM CAH CORTISOL
|
Facility
IP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.43
|
| Rate for Payer: Cash Price |
$19.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.00
|
| Rate for Payer: Heritage Provider Network Senior |
$29.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
|
|
HC SOM CAH CORTISOL
|
Facility
OP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$136.59 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.45
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.59
|
| Rate for Payer: Blue Shield of California Commercial |
$127.34
|
| Rate for Payer: Blue Shield of California EPN |
$99.55
|
| Rate for Payer: Cash Price |
$19.28
|
| Rate for Payer: Cash Price |
$19.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$27.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Senior |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.52
|
| Rate for Payer: Heritage Provider Network Senior |
$26.52
|
| Rate for Payer: Humana Medicare |
$16.30
|
| Rate for Payer: IEHP Medi-Cal |
$22.60
|
| Rate for Payer: IEHP Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.30
|
| Rate for Payer: TriValley Medical Group Senior |
$16.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
OP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$211.54 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.54
|
| Rate for Payer: Blue Shield of California Commercial |
$197.38
|
| Rate for Payer: Blue Shield of California EPN |
$154.30
|
| Rate for Payer: Cash Price |
$29.88
|
| Rate for Payer: Cash Price |
$29.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Senior |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.11
|
| Rate for Payer: Heritage Provider Network Senior |
$41.11
|
| Rate for Payer: Humana Medicare |
$25.27
|
| Rate for Payer: IEHP Medi-Cal |
$35.05
|
| Rate for Payer: IEHP Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.84
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.27
|
| Rate for Payer: TriValley Medical Group Senior |
$25.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
IP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$49.81 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.62
|
| Rate for Payer: Cash Price |
$29.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.96
|
| Rate for Payer: Heritage Provider Network Senior |
$44.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
IP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$61.06 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.94
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.12
|
| Rate for Payer: Heritage Provider Network Senior |
$55.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
OP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$250.87 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.87
|
| Rate for Payer: Blue Shield of California Commercial |
$241.94
|
| Rate for Payer: Blue Shield of California EPN |
$189.13
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Cash Price |
$36.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$52.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Senior |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$30.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Senior |
$50.40
|
| Rate for Payer: Humana Medicare |
$30.98
|
| Rate for Payer: IEHP Medi-Cal |
$42.96
|
| Rate for Payer: IEHP Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$58.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.98
|
| Rate for Payer: TriValley Medical Group Senior |
$30.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
IP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$41.12 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.67
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.12
|
| Rate for Payer: Heritage Provider Network Senior |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
OP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA Gatekeeper |
$60.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.63
|
| Rate for Payer: Blue Shield of California Commercial |
$162.95
|
| Rate for Payer: Blue Shield of California EPN |
$127.39
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Cash Price |
$24.67
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.94
|
| Rate for Payer: Heritage Provider Network Senior |
$33.94
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: IEHP Medi-Cal |
$28.55
|
| Rate for Payer: IEHP Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.86
|
| Rate for Payer: TriValley Medical Group Senior |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
OP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$216.05 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Gatekeeper |
$75.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.05
|
| Rate for Payer: Blue Shield of California Commercial |
$201.69
|
| Rate for Payer: Blue Shield of California EPN |
$157.67
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.99
|
| Rate for Payer: Heritage Provider Network Senior |
$41.99
|
| Rate for Payer: Humana Medicare |
$25.81
|
| Rate for Payer: IEHP Medi-Cal |
$35.57
|
| Rate for Payer: IEHP Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
IP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$50.87 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.60
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.92
|
| Rate for Payer: Heritage Provider Network Senior |
$45.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.96
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
|
|
HC SOM CALCITONIN
|
Facility
IP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM CALCITONIN
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.16
|
| Rate for Payer: Blue Shield of California Commercial |
$209.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.48
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Senior |
$26.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$26.79
|
| Rate for Payer: IEHP Medi-Cal |
$37.14
|
| Rate for Payer: IEHP Medicare Advantage |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.76
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.79
|
| Rate for Payer: TriValley Medical Group Senior |
$26.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$28.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
HC SOM CALPROTECTIN
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
