|
HC SOM HCG HIGH SENSITIVITY
|
Facility
OP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.59
|
| Rate for Payer: Blue Shield of California Commercial |
$117.56
|
| Rate for Payer: Blue Shield of California EPN |
$91.90
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.38
|
| Rate for Payer: Heritage Provider Network Senior |
$10.38
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: IEHP Medi-Cal |
$20.65
|
| Rate for Payer: IEHP Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
IP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.52
|
| Rate for Payer: Cash Price |
$7.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.35
|
| Rate for Payer: Heritage Provider Network Senior |
$11.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$12.58
|
|
|
HC SOM HCV GENOTYPING
|
Facility
OP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$2,153.45 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Gatekeeper |
$749.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,153.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,010.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,571.85
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.20
|
| Rate for Payer: Dignity Health Senior |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.61
|
| Rate for Payer: EPIC Health Plan Medicare |
$257.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.72
|
| Rate for Payer: Heritage Provider Network Senior |
$77.72
|
| Rate for Payer: Humana Medicare |
$257.45
|
| Rate for Payer: IEHP Medi-Cal |
$356.99
|
| Rate for Payer: IEHP Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$489.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$324.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$257.45
|
| Rate for Payer: TriValley Medical Group Senior |
$257.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$278.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$278.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.20
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM HCV GENOTYPING
|
Facility
IP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.25
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.00
|
| Rate for Payer: Heritage Provider Network Senior |
$85.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$94.16
|
|
|
HC SOM HEMO A INV INTERP
|
Facility
OP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$1,252.63 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$145.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.95
|
| 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 |
$343.44
|
| Rate for Payer: Blue Shield of California EPN |
$324.64
|
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.48
|
| 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 |
$359.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.34
|
| Rate for Payer: Heritage Provider Network Senior |
$342.34
|
| 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 |
$100.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$218.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.26
|
| 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 |
$414.79
|
| 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 SOM HEMO A INV INTERP
|
Facility
IP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$414.79 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.95
|
| Rate for Payer: Cash Price |
$248.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.41
|
| Rate for Payer: Heritage Provider Network Senior |
$374.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.26
|
| Rate for Payer: Multiplan Commercial |
$414.79
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
IP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$71.88 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.84
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.88
|
| Rate for Payer: Heritage Provider Network Senior |
$64.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.96
|
| Rate for Payer: Multiplan Commercial |
$71.88
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
OP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$450.81 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.81
|
| Rate for Payer: Blue Shield of California Commercial |
$59.52
|
| Rate for Payer: Blue Shield of California EPN |
$56.26
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cash Price |
$43.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.90
|
| Rate for Payer: Dignity Health Senior |
$65.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.32
|
| Rate for Payer: Heritage Provider Network Senior |
$59.32
|
| Rate for Payer: Humana Medicare |
$65.36
|
| Rate for Payer: IEHP Medi-Cal |
$87.61
|
| Rate for Payer: IEHP Medicare Advantage |
$65.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$71.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.36
|
| Rate for Payer: TriValley Medical Group Senior |
$65.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HEMOGLOBIN QUAL URINE
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900912526
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
|
|
HC SOM HEMOGLOBIN QUAL URINE
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900912526
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$19.96 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.89
|
| Rate for Payer: Blue Shield of California Commercial |
$19.96
|
| Rate for Payer: Blue Shield of California EPN |
$15.60
|
| 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 |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: Dignity Health Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$3.48
|
| Rate for Payer: IEHP Medi-Cal |
$3.35
|
| Rate for Payer: IEHP Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.48
|
| Rate for Payer: TriValley Medical Group Senior |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: IEHP Medi-Cal |
$6.58
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| 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 SOM HEPARIN-PF4 AB
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$143.44 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$53.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.45
|
| Rate for Payer: Blue Shield of California Commercial |
$143.44
|
| Rate for Payer: Blue Shield of California EPN |
$112.13
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| Rate for Payer: Humana Medicare |
$18.37
|
| Rate for Payer: IEHP Medi-Cal |
$25.47
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.15
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.37
|
| Rate for Payer: TriValley Medical Group Senior |
$18.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
IP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$15.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.50
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.71
|
| Rate for Payer: Heritage Provider Network Senior |
$53.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.83
|
| Rate for Payer: Multiplan Commercial |
$59.50
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
OP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$334.56 |
| Rate for Payer: Adventist Health Commercial |
$15.87
|
| Rate for Payer: Aetna of CA Gatekeeper |
$124.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare 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 |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.56
|
| 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 |
$51.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$42.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$49.11
|
| Rate for Payer: Heritage Provider Network Senior |
$49.11
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: IEHP Medi-Cal |
$59.40
|
| Rate for Payer: IEHP Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.83
|
| 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 |
$59.50
|
| 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 SOM HEPATITIS BE AB
|
Facility
OP
|
$12.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$93.66 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.66
|
| Rate for Payer: Blue Shield of California Commercial |
$90.33
|
| Rate for Payer: Blue Shield of California EPN |
$70.62
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Humana Medicare |
$11.57
|
| Rate for Payer: IEHP Medi-Cal |
$7.30
|
| Rate for Payer: IEHP Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.57
|
| Rate for Payer: TriValley Medical Group Senior |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
IP
|
$12.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.24
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC SOM HEPATITIS D ANTIBODY
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
900910354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$134.85 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.85
|
| Rate for Payer: Blue Shield of California Commercial |
$134.05
|
| Rate for Payer: Blue Shield of California EPN |
$104.79
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.88
|
| Rate for Payer: Dignity Health Senior |
$17.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.14
|
| Rate for Payer: Heritage Provider Network Senior |
$37.14
|
| Rate for Payer: Humana Medicare |
$17.16
|
| Rate for Payer: IEHP Medi-Cal |
$23.79
|
| Rate for Payer: IEHP Medicare Advantage |
$17.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.62
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.16
|
| Rate for Payer: TriValley Medical Group Senior |
$17.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.88
|
| Rate for Payer: Vantage Medical Group Senior |
$17.16
|
|
|
HC SOM HHEMO 81256
|
Facility
IP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.76
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.05
|
| Rate for Payer: Heritage Provider Network Senior |
$48.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$53.24
|
|
|
HC SOM HHEMO 81256
|
Facility
OP
|
$70.98
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900914875
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$450.81 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.81
|
| Rate for Payer: Blue Shield of California Commercial |
$44.08
|
| Rate for Payer: Blue Shield of California EPN |
$41.67
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.90
|
| Rate for Payer: Dignity Health Senior |
$65.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.14
|
| Rate for Payer: EPIC Health Plan Medicare |
$65.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.94
|
| Rate for Payer: Heritage Provider Network Senior |
$43.94
|
| Rate for Payer: Humana Medicare |
$65.36
|
| Rate for Payer: IEHP Medi-Cal |
$87.61
|
| Rate for Payer: IEHP Medicare Advantage |
$65.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$124.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.35
|
| Rate for Payer: Multiplan Commercial |
$53.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$65.36
|
| Rate for Payer: TriValley Medical Group Senior |
$65.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$70.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.24
|
| Rate for Payer: Heritage Provider Network Senior |
$81.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
|
|
HC SOM HISTAMINE PLASMA
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 83088
|
| Hospital Charge Code |
900914665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$247.16 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$85.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$82.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.16
|
| Rate for Payer: Blue Shield of California Commercial |
$230.64
|
| Rate for Payer: Blue Shield of California EPN |
$180.31
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.48
|
| Rate for Payer: Dignity Health Senior |
$29.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.28
|
| Rate for Payer: Heritage Provider Network Senior |
$74.28
|
| Rate for Payer: Humana Medicare |
$29.53
|
| Rate for Payer: IEHP Medi-Cal |
$40.95
|
| Rate for Payer: IEHP Medicare Advantage |
$29.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.21
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.53
|
| Rate for Payer: TriValley Medical Group Senior |
$29.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.48
|
| Rate for Payer: Vantage Medical Group Senior |
$29.53
|
|
|
HC SOM HISTOPLAS BLASTOMYC PCR1
|
Facility
IP
|
$148.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914670
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$111.09 |
| Rate for Payer: Adventist Health Commercial |
$29.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.76
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$100.28
|
| Rate for Payer: Heritage Provider Network Senior |
$100.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.03
|
| Rate for Payer: Multiplan Commercial |
$111.09
|
|
