|
HC SONOHYSTEROGRAPHY W COLOR DOPP
|
Facility
IP
|
$914.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
950402003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.43 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.78
|
| Rate for Payer: Heritage Provider Network Senior |
$618.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
|
|
HC SONOHYSTEROGRAPHY W COLOR DOPP
|
Facility
OP
|
$914.00
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
950402003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: Adventist Health Commercial |
$182.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$201.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$627.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Blue Shield of California Commercial |
$312.13
|
| Rate for Payer: Blue Shield of California EPN |
$177.50
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$594.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$565.77
|
| Rate for Payer: Heritage Provider Network Senior |
$565.77
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$117.81
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$685.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC SOP CELIAC PLUS
|
Facility
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.17
|
| Rate for Payer: Blue Shield of California Commercial |
$79.18
|
| Rate for Payer: Blue Shield of California EPN |
$74.84
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.92
|
| Rate for Payer: Heritage Provider Network Senior |
$78.92
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$87.44
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SOP CELIAC PLUS
|
Facility
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.59
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.32
|
| Rate for Payer: Heritage Provider Network Senior |
$86.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
IP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$207.19 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.78
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$187.02
|
| Rate for Payer: Heritage Provider Network Senior |
$187.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.06
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
OP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$704.95 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$140.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$189.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$704.95
|
| Rate for Payer: Blue Shield of California Commercial |
$171.55
|
| Rate for Payer: Blue Shield of California EPN |
$162.16
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$179.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Senior |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.56
|
| Rate for Payer: EPIC Health Plan Medicare |
$123.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$171.00
|
| Rate for Payer: Heritage Provider Network Senior |
$171.00
|
| Rate for Payer: Humana Medicare |
$123.68
|
| Rate for Payer: IEHP Medi-Cal |
$171.51
|
| Rate for Payer: IEHP Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$234.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.84
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$123.68
|
| Rate for Payer: TriValley Medical Group Senior |
$123.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
IP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.61
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.39
|
| Rate for Payer: Heritage Provider Network Senior |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.32
|
| Rate for Payer: Multiplan Commercial |
$15.94
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
OP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.61
|
| Rate for Payer: Blue Shield of California EPN |
$56.77
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Senior |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.16
|
| Rate for Payer: Heritage Provider Network Senior |
$13.16
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: IEHP Medi-Cal |
$9.48
|
| Rate for Payer: IEHP Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.72
|
| Rate for Payer: Multiplan Commercial |
$15.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.30
|
| Rate for Payer: TriValley Medical Group Senior |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
IP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.38
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.06
|
| Rate for Payer: Heritage Provider Network Senior |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.14
|
| Rate for Payer: Multiplan Commercial |
$24.44
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
OP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22.38
|
| 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 |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21.18
|
| 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 |
$21.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.17
|
| Rate for Payer: Heritage Provider Network Senior |
$20.17
|
| 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 |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.14
|
| 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 |
$24.44
|
| 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 SOP CELIAC SEROLOGY
|
Facility
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$405.48 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$135.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.17
|
| Rate for Payer: Blue Shield of California Commercial |
$79.18
|
| Rate for Payer: Blue Shield of California EPN |
$74.84
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: Dignity Health Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.88
|
| Rate for Payer: EPIC Health Plan Medicare |
$213.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.92
|
| Rate for Payer: Heritage Provider Network Senior |
$78.92
|
| Rate for Payer: Humana Medicare |
$213.41
|
| Rate for Payer: IEHP Medi-Cal |
$87.44
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$405.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.90
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: TriValley Medical Group Commercial |
$213.41
|
| Rate for Payer: TriValley Medical Group Senior |
$213.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$321.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$321.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$95.62 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.59
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$86.32
|
| Rate for Payer: Heritage Provider Network Senior |
$86.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.88
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
|
|
HC SOP TPMT ENZYME
|
Facility
IP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$70.12 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.23
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.30
|
| Rate for Payer: Heritage Provider Network Senior |
$63.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.38
|
| Rate for Payer: Multiplan Commercial |
$70.12
|
|
|
HC SOP TPMT ENZYME
|
Facility
OP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$150.51 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$52.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$64.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.51
|
| Rate for Payer: Blue Shield of California Commercial |
$141.04
|
| Rate for Payer: Blue Shield of California EPN |
$110.26
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.78
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.88
|
| Rate for Payer: Heritage Provider Network Senior |
$57.88
|
| Rate for Payer: Humana Medicare |
$24.09
|
| Rate for Payer: IEHP Medi-Cal |
$23.95
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.35
|
| Rate for Payer: Multiplan Commercial |
$70.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.09
|
| Rate for Payer: TriValley Medical Group Senior |
$24.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.56
|
| Rate for Payer: Blue Shield of California EPN |
$91.90
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$112.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: Dignity Health Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$15.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.09
|
| Rate for Payer: Heritage Provider Network Senior |
$107.09
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: IEHP Medi-Cal |
$20.87
|
| Rate for Payer: IEHP Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$28.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$15.05
|
| Rate for Payer: TriValley Medical Group Senior |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$16.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$118.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Senior |
$117.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.25
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
|
|
HC SOQ SARS-COV-2
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$301.99 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.99
|
| Rate for Payer: Blue Shield of California Commercial |
$49.06
|
| Rate for Payer: Blue Shield of California EPN |
$46.37
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$51.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$51.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.90
|
| Rate for Payer: Heritage Provider Network Senior |
$48.90
|
| Rate for Payer: Humana Medicare |
$51.31
|
| Rate for Payer: IEHP Medi-Cal |
$80.04
|
| Rate for Payer: IEHP Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.65
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$51.31
|
| Rate for Payer: TriValley Medical Group Senior |
$51.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$55.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$55.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOQ SARS-COV-2
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.27
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$53.48
|
| Rate for Payer: Heritage Provider Network Senior |
$53.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
|
|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.77
|
| Rate for Payer: Heritage Provider Network Senior |
$6.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
|
|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$35.73 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: IEHP Medi-Cal |
$5.82
|
| Rate for Payer: IEHP Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.27
|
| Rate for Payer: TriValley Medical Group Senior |
$4.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.23
|
| Rate for Payer: Blue Shield of California Commercial |
$274.13
|
| Rate for Payer: Blue Shield of California EPN |
$214.30
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$65.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Senior |
$41.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.90
|
| Rate for Payer: Heritage Provider Network Senior |
$61.90
|
| Rate for Payer: Humana Medicare |
$41.68
|
| Rate for Payer: IEHP Medi-Cal |
$52.01
|
| Rate for Payer: IEHP Medicare Advantage |
$41.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.52
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.68
|
| Rate for Payer: TriValley Medical Group Senior |
$41.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$45.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOSTL ABPA ALLERG SP IGE
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$132.31 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| 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 |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Senior |
$15.48
|
| 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 |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| 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 |
$18.75
|
| 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 SOSTL ABPA ALLERG SP IGE
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
|
HC SOSTL ABPA ALLERG SP IGG
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.18
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.92
|
| Rate for Payer: Heritage Provider Network Senior |
$16.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
|
