|
HC SOM META 1-25
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,205.63 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$377.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.61
|
| Rate for Payer: Blue Shield of California EPN |
$908.87
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Senior |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$173.17
|
| Rate for Payer: IEHP Medi-Cal |
$236.68
|
| Rate for Payer: IEHP Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.19
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.17
|
| Rate for Payer: TriValley Medical Group Senior |
$173.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META 20-25
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,038.61 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,038.61
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$113.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$108.32
|
| Rate for Payer: Heritage Provider Network Senior |
$108.32
|
| Rate for Payer: Humana Medicare |
$144.61
|
| Rate for Payer: IEHP Medi-Cal |
$180.46
|
| Rate for Payer: IEHP Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$274.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 20-25
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$120.22
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.48
|
| Rate for Payer: Heritage Provider Network Senior |
$118.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.75
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
OP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$148.36 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.07
|
| Rate for Payer: Blue Shield of California Commercial |
$148.36
|
| Rate for Payer: Blue Shield of California EPN |
$115.98
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.40
|
| Rate for Payer: Heritage Provider Network Senior |
$7.40
|
| Rate for Payer: Humana Medicare |
$26.91
|
| Rate for Payer: IEHP Medi-Cal |
$11.86
|
| Rate for Payer: IEHP Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
IP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.21
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.09
|
| Rate for Payer: Heritage Provider Network Senior |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
IP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$84.79 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.67
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.53
|
| Rate for Payer: Heritage Provider Network Senior |
$76.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.26
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
OP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$1,504.68 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Aetna of CA Gatekeeper |
$523.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$77.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,404.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.61
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Cash Price |
$50.87
|
| Rate for Payer: Cigna of CA HMO/PPO |
$73.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.98
|
| Rate for Payer: Heritage Provider Network Senior |
$69.98
|
| Rate for Payer: Humana Medicare |
$188.57
|
| Rate for Payer: IEHP Medi-Cal |
$249.29
|
| Rate for Payer: IEHP Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$358.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
IP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.43
|
| Rate for Payer: Heritage Provider Network Senior |
$73.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
OP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$1,043.23 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.23
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Senior |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$125.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: IEHP Medi-Cal |
$168.18
|
| Rate for Payer: IEHP Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$238.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$148.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.12
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.49
|
| Rate for Payer: TriValley Medical Group Senior |
$125.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$135.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$135.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
OP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$148.36 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.07
|
| Rate for Payer: Blue Shield of California Commercial |
$148.36
|
| Rate for Payer: Blue Shield of California EPN |
$115.98
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.24
|
| Rate for Payer: Heritage Provider Network Senior |
$10.24
|
| Rate for Payer: Humana Medicare |
$26.91
|
| Rate for Payer: IEHP Medi-Cal |
$11.86
|
| Rate for Payer: IEHP Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
IP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.36
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.20
|
| Rate for Payer: Heritage Provider Network Senior |
$11.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
OP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$1,038.61 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,038.61
|
| Rate for Payer: Blue Shield of California Commercial |
$973.44
|
| Rate for Payer: Blue Shield of California EPN |
$760.99
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Senior |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$144.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.14
|
| Rate for Payer: Heritage Provider Network Senior |
$67.14
|
| Rate for Payer: Humana Medicare |
$144.61
|
| Rate for Payer: IEHP Medi-Cal |
$180.46
|
| Rate for Payer: IEHP Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$274.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.21
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$144.61
|
| Rate for Payer: TriValley Medical Group Senior |
$144.61
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$156.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
IP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.51
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.43
|
| Rate for Payer: Heritage Provider Network Senior |
$73.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
OP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$148.36 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Gatekeeper |
$55.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.07
|
| Rate for Payer: Blue Shield of California Commercial |
$148.36
|
| Rate for Payer: Blue Shield of California EPN |
$115.98
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Senior |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$26.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.76
|
| Rate for Payer: Heritage Provider Network Senior |
$8.76
|
| Rate for Payer: Humana Medicare |
$26.91
|
| Rate for Payer: IEHP Medi-Cal |
$11.86
|
| Rate for Payer: IEHP Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$51.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$26.91
|
| Rate for Payer: TriValley Medical Group Senior |
$26.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
IP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.61 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.72
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.58
|
| Rate for Payer: Heritage Provider Network Senior |
$9.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.54
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
OP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$1,205.63 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$377.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,205.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.61
|
| Rate for Payer: Blue Shield of California EPN |
$908.87
|
| Rate for Payer: Cash Price |
$49.88
|
| Rate for Payer: Cash Price |
$49.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$72.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Senior |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$173.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.62
|
| Rate for Payer: Heritage Provider Network Senior |
$68.62
|
| Rate for Payer: Humana Medicare |
$173.17
|
| Rate for Payer: IEHP Medi-Cal |
$236.68
|
| Rate for Payer: IEHP Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$329.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.19
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
| Rate for Payer: TriValley Medical Group Commercial |
$173.17
|
| Rate for Payer: TriValley Medical Group Senior |
$173.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$187.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$187.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
IP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$83.14 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.15
|
| Rate for Payer: Cash Price |
$49.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.05
|
| Rate for Payer: Heritage Provider Network Senior |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
|
|
HC SOM META LT 15
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC SOM META LT 15
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$1,504.68 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$523.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,404.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.61
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Senior |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$188.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Humana Medicare |
$188.57
|
| Rate for Payer: IEHP Medi-Cal |
$249.29
|
| Rate for Payer: IEHP Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$358.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.60
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.57
|
| Rate for Payer: TriValley Medical Group Senior |
$188.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$203.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$203.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
IP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.67
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.42
|
| Rate for Payer: Heritage Provider Network Senior |
$16.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
OP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$141.84 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.84
|
| Rate for Payer: Blue Shield of California Commercial |
$132.32
|
| Rate for Payer: Blue Shield of California EPN |
$103.44
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cigna of CA HMO/PPO |
$15.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.77
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.02
|
| Rate for Payer: Heritage Provider Network Senior |
$15.02
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: IEHP Medi-Cal |
$23.49
|
| Rate for Payer: IEHP Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.94
|
| Rate for Payer: TriValley Medical Group Senior |
$16.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
IP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.37
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.23
|
| Rate for Payer: Heritage Provider Network Senior |
$77.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
OP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$78.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.13
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Senior |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.62
|
| Rate for Payer: Heritage Provider Network Senior |
$70.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$54.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
OP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$124.82 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.82
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.75
|
| Rate for Payer: Dignity Health Senior |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.02
|
| Rate for Payer: Heritage Provider Network Senior |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13.75
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
IP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.95
|
| Rate for Payer: Heritage Provider Network Senior |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.04
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
|
