|
HC SOM METHYLMALONIC ACID
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$137.72 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.72
|
| Rate for Payer: Blue Shield of California Commercial |
$128.57
|
| Rate for Payer: Blue Shield of California EPN |
$100.51
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$21.21
|
| Rate for Payer: IEHP Medi-Cal |
$22.90
|
| Rate for Payer: IEHP Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$137.72 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.72
|
| Rate for Payer: Blue Shield of California Commercial |
$128.57
|
| Rate for Payer: Blue Shield of California EPN |
$100.51
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Humana Medicare |
$21.21
|
| Rate for Payer: IEHP Medi-Cal |
$22.90
|
| Rate for Payer: IEHP Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.72
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.21
|
| Rate for Payer: TriValley Medical Group Senior |
$21.21
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
OP
|
$266.46
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Adventist Health Commercial |
$53.29
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Cash Price |
$119.91
|
| Rate for Payer: Cash Price |
$119.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$164.94
|
| Rate for Payer: Heritage Provider Network Senior |
$164.94
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: IEHP Medi-Cal |
$19.64
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.49
|
| Rate for Payer: Multiplan Commercial |
$199.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.64
|
| Rate for Payer: TriValley Medical Group Senior |
$18.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
IP
|
$266.46
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Adventist Health Commercial |
$53.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.06
|
| Rate for Payer: Cash Price |
$119.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.39
|
| Rate for Payer: Heritage Provider Network Senior |
$180.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.62
|
| Rate for Payer: Multiplan Commercial |
$199.84
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$166.51
|
| Rate for Payer: Heritage Provider Network Senior |
$166.51
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.80
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.11
|
| Rate for Payer: Heritage Provider Network Senior |
$182.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.25
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
|
|
HC SOM MGLES 83519A
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519A
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519B
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519B
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519C
|
Facility
OP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.17
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.25
|
| Rate for Payer: Heritage Provider Network Senior |
$78.25
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519C
|
Facility
IP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.81 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.58
|
| Rate for Payer: Heritage Provider Network Senior |
$85.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
|
|
HC SOM MGLES 83519D
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$94.80 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$85.57
|
| Rate for Payer: Heritage Provider Network Senior |
$85.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
|
|
HC SOM MGLES 83519D
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.10
|
| Rate for Payer: Blue Shield of California Commercial |
$105.54
|
| Rate for Payer: Blue Shield of California EPN |
$82.51
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$18.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.24
|
| Rate for Payer: Heritage Provider Network Senior |
$78.24
|
| Rate for Payer: Humana Medicare |
$18.40
|
| Rate for Payer: IEHP Medi-Cal |
$19.14
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$34.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83520
|
Facility
OP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.36
|
| 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 |
$54.53
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Cigna of CA HMO/PPO |
$78.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Senior |
$75.00
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: IEHP Medi-Cal |
$15.97
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.76
|
| Rate for Payer: Multiplan Commercial |
$90.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM MGLES 83520
|
Facility
IP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.24
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.03
|
| Rate for Payer: Heritage Provider Network Senior |
$82.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.29
|
| Rate for Payer: Multiplan Commercial |
$90.88
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
IP
|
$100.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Adventist Health Commercial |
$20.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.74
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.74
|
| Rate for Payer: Heritage Provider Network Senior |
$67.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
OP
|
$100.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$75.04 |
| Rate for Payer: Adventist Health Commercial |
$20.01
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.90
|
| Rate for Payer: Blue Shield of California Commercial |
$52.15
|
| Rate for Payer: Blue Shield of California EPN |
$40.77
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.94
|
| Rate for Payer: Heritage Provider Network Senior |
$61.94
|
| Rate for Payer: Humana Medicare |
$6.68
|
| Rate for Payer: IEHP Medi-Cal |
$9.06
|
| Rate for Payer: IEHP Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.68
|
| Rate for Payer: TriValley Medical Group Senior |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
OP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$67.29 |
| Rate for Payer: Adventist Health Commercial |
$17.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$17.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.15
|
| Rate for Payer: Blue Shield of California Commercial |
$46.79
|
| Rate for Payer: Blue Shield of California EPN |
$36.58
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.54
|
| Rate for Payer: Heritage Provider Network Senior |
$55.54
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: IEHP Medi-Cal |
$8.31
|
| Rate for Payer: IEHP Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.55
|
| Rate for Payer: Multiplan Commercial |
$67.29
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.99
|
| Rate for Payer: TriValley Medical Group Senior |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
IP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$67.29 |
| Rate for Payer: Adventist Health Commercial |
$17.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.64
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.74
|
| Rate for Payer: Heritage Provider Network Senior |
$60.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.43
|
| Rate for Payer: Multiplan Commercial |
$67.29
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$31.90
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$2.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2.94
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: IEHP Medi-Cal |
$7.24
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.58
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3.26
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.19
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
|
|
HC SOM MIRA VISTA HC HISTOPLASMA AG
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
900913883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.34 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.18
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.78
|
| Rate for Payer: Heritage Provider Network Senior |
$94.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
|
