|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$79.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$215.61
|
| Rate for Payer: Blue Shield of California EPN |
$168.55
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$38.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$92.85
|
| Rate for Payer: Heritage Provider Network Senior |
$92.85
|
| Rate for Payer: Humana Medicare |
$38.57
|
| Rate for Payer: IEHP Medi-Cal |
$48.14
|
| Rate for Payer: IEHP Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC SOM LEGIONELLA AB
|
Facility
IP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Adventist Health Commercial |
$2.98
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.24
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.09
|
| Rate for Payer: Heritage Provider Network Senior |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
|
|
HC SOM LEGIONELLA AB
|
Facility
OP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Adventist Health Commercial |
$2.98
|
| Rate for Payer: Aetna of CA Gatekeeper |
$44.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.23
|
| Rate for Payer: Blue Shield of California Commercial |
$119.57
|
| Rate for Payer: Blue Shield of California EPN |
$93.47
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.22
|
| Rate for Payer: Heritage Provider Network Senior |
$9.22
|
| Rate for Payer: Humana Medicare |
$15.30
|
| Rate for Payer: IEHP Medi-Cal |
$21.22
|
| Rate for Payer: IEHP Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
OP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.95
|
| Rate for Payer: Heritage Provider Network Senior |
$9.95
|
| Rate for Payer: Humana Medicare |
$16.07
|
| Rate for Payer: IEHP Medi-Cal |
$7.60
|
| Rate for Payer: IEHP Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
IP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$12.05 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.04
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$72.56 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.90
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.82
|
| Rate for Payer: Dignity Health Senior |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Humana Medicare |
$16.20
|
| Rate for Payer: IEHP Medi-Cal |
$19.08
|
| Rate for Payer: IEHP Medicare Advantage |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$30.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.41
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
IP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.96
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Heritage Provider Network Senior |
$9.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
OP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$101.12 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.72
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.58
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.98
|
| Rate for Payer: Heritage Provider Network Senior |
$8.98
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: IEHP Medi-Cal |
$18.38
|
| Rate for Payer: IEHP Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LIPASE BF
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$53.78
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPASE BF
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
IP
|
$57.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Adventist Health Commercial |
$11.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.23
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.66
|
| Rate for Payer: Heritage Provider Network Senior |
$38.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
OP
|
$57.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Adventist Health Commercial |
$11.42
|
| Rate for Payer: Aetna of CA Gatekeeper |
$20.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$53.78
|
| Rate for Payer: Blue Shield of California EPN |
$42.04
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.34
|
| Rate for Payer: Heritage Provider Network Senior |
$35.34
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$42.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
OP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.00
|
| Rate for Payer: Blue Shield of California Commercial |
$101.12
|
| Rate for Payer: Blue Shield of California EPN |
$79.05
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.07
|
| Rate for Payer: Heritage Provider Network Senior |
$9.07
|
| Rate for Payer: Humana Medicare |
$14.32
|
| Rate for Payer: IEHP Medi-Cal |
$17.96
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.04
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.32
|
| Rate for Payer: TriValley Medical Group Senior |
$14.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
IP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: Adventist Health Commercial |
$2.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.06
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.92
|
| Rate for Payer: Heritage Provider Network Senior |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$180.77 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.77
|
| Rate for Payer: Blue Shield of California Commercial |
$120.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.57
|
| 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 |
$23.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.04
|
| Rate for Payer: Dignity Health Senior |
$15.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$15.49
|
| Rate for Payer: IEHP Medi-Cal |
$21.48
|
| Rate for Payer: IEHP Medicare Advantage |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.49
|
| Rate for Payer: TriValley Medical Group Senior |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| 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 LYME DISEASE AB IGM
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| 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 LYME DISEASE AB IGM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$180.77 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.77
|
| Rate for Payer: Blue Shield of California Commercial |
$120.97
|
| Rate for Payer: Blue Shield of California EPN |
$94.57
|
| 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 |
$23.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.04
|
| Rate for Payer: Dignity Health Senior |
$15.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.28
|
| Rate for Payer: Heritage Provider Network Senior |
$9.28
|
| Rate for Payer: Humana Medicare |
$15.49
|
| Rate for Payer: IEHP Medi-Cal |
$21.48
|
| Rate for Payer: IEHP Medicare Advantage |
$15.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.52
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.49
|
| Rate for Payer: TriValley Medical Group Senior |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
OP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$134.85 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.85
|
| Rate for Payer: Blue Shield of California Commercial |
$133.04
|
| Rate for Payer: Blue Shield of California EPN |
$104.01
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Senior |
$17.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.09
|
| Rate for Payer: Heritage Provider Network Senior |
$10.09
|
| Rate for Payer: Humana Medicare |
$17.03
|
| Rate for Payer: IEHP Medi-Cal |
$23.62
|
| Rate for Payer: IEHP Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.46
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.03
|
| Rate for Payer: TriValley Medical Group Senior |
$17.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
IP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$12.22 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.20
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.04
|
| Rate for Payer: Heritage Provider Network Senior |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.49
|
| Rate for Payer: Blue Shield of California Commercial |
$117.11
|
| Rate for Payer: Blue Shield of California EPN |
$91.55
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$80.47
|
| Rate for Payer: Heritage Provider Network Senior |
$80.47
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: IEHP Medi-Cal |
$16.36
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.89
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.99
|
| Rate for Payer: TriValley Medical Group Senior |
$14.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$89.31
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$88.01
|
| Rate for Payer: Heritage Provider Network Senior |
$88.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
|
|
HC SOM LYSO 86003
|
Facility
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.13
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.06
|
| Rate for Payer: Heritage Provider Network Senior |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
|
