|
HC SOM LD ISOENZYMES
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$121.32 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.32
|
| Rate for Payer: Blue Shield of California Commercial |
$102.99
|
| Rate for Payer: Blue Shield of California EPN |
$82.61
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.95
|
| Rate for Payer: Heritage Provider Network Senior |
$6.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.79
|
| Rate for Payer: TriValley Medical Group Senior |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Vantage Medical Group Senior |
$12.79
|
|
|
HC SOM LD ISOENZYMES
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.23
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.60
|
| Rate for Payer: Heritage Provider Network Senior |
$7.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.86
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$114.93 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.93
|
| Rate for Payer: Blue Shield of California Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California EPN |
$78.12
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.37
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.63
|
| Rate for Payer: Heritage Provider Network Senior |
$5.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD URINE
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$114.93 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.93
|
| Rate for Payer: Blue Shield of California Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California EPN |
$78.12
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.55
|
| Rate for Payer: Heritage Provider Network Senior |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.11
|
| Rate for Payer: TriValley Medical Group Senior |
$12.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD URINE
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.29
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.28
|
| Rate for Payer: Heritage Provider Network Senior |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$22.47
|
|
|
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 |
$222.16 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$92.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.76
|
| Rate for Payer: Blue Shield of California Commercial |
$222.16
|
| Rate for Payer: Blue Shield of California EPN |
$178.19
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$97.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.50
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| 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 |
$57.85
|
| 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 |
$96.60
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$22.71
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$17.03 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.63
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.37
|
| Rate for Payer: Heritage Provider Network Senior |
$15.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.68
|
| Rate for Payer: Multiplan Commercial |
$17.03
|
|
|
HC SOM LEGIONELLA AB
|
Facility
|
OP
|
$22.71
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$143.19 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.19
|
| Rate for Payer: Blue Shield of California Commercial |
$123.21
|
| Rate for Payer: Blue Shield of California EPN |
$98.82
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.06
|
| Rate for Payer: Heritage Provider Network Senior |
$14.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$17.03
|
| 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
|
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 |
$10.35
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.88
|
| Rate for Payer: Heritage Provider Network Senior |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
|
|
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 |
$85.34 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.34
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| 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 |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC SOM LEGIONELLA PCR
|
Facility
|
OP
|
$57.50
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.03
|
| Rate for Payer: Blue Shield of California Commercial |
$564.88
|
| Rate for Payer: Blue Shield of California EPN |
$453.08
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.59
|
| Rate for Payer: Heritage Provider Network Senior |
$35.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$27.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.07
|
| Rate for Payer: Multiplan Commercial |
$43.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$75.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$75.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Vantage Medical Group Senior |
$70.20
|
|
|
HC SOM LEGIONELLA PCR
|
Facility
|
IP
|
$57.50
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$43.12 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.03
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.93
|
| Rate for Payer: Heritage Provider Network Senior |
$38.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Multiplan Commercial |
$43.12
|
|
|
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 |
$81.56 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.56
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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 Medicare Advantage |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.71
|
| 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 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 |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$104.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.68
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| 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 |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LIPASE BF
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.33
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California EPN |
$44.44
|
| Rate for Payer: Blue Shield of California EPN |
$44.44
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.89
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$7.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
| 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 |
$4.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16.10
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.93
|
| Rate for Payer: Heritage Provider Network Senior |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| 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
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$50.33 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.21
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.43
|
| Rate for Payer: Heritage Provider Network Senior |
$45.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$50.33
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
|
OP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.33
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California EPN |
$44.44
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$43.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.53
|
| Rate for Payer: Heritage Provider Network Senior |
$41.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$32.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$50.33
|
| 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
|
$12.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$120.24 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.24
|
| Rate for Payer: Blue Shield of California Commercial |
$104.20
|
| Rate for Payer: Blue Shield of California EPN |
$83.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| 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
|
$12.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7.73
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Heritage Provider Network Senior |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
