|
HC HISTOCHEM STAIN/MUSCLE BIOPSY
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$762.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.42
|
| Rate for Payer: Blue Distinction Transplant |
$213.60
|
| Rate for Payer: Blue Shield of California Commercial |
$229.98
|
| Rate for Payer: Blue Shield of California EPN |
$182.27
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cigna of CA HMO |
$227.84
|
| Rate for Payer: Cigna of CA PPO |
$263.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$267.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC HISTONE AUTO AB
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900913528
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$110.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.01
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: Dignity Health Media |
$12.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC HIV 1 2 AB CONFIRMATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900913681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$128.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.93
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Media |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HIV-1,2 AG AB SCREEN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$201.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.36
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.24
|
| Rate for Payer: Blue Shield of California EPN |
$27.14
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Media |
$24.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV 1 ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
900913682
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.02
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.34
|
| Rate for Payer: Dignity Health Media |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.58
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.20
|
| Rate for Payer: United Healthcare All Other HMO |
$7.20
|
| Rate for Payer: United Healthcare HMO Rider |
$7.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.78
|
| Rate for Payer: Vantage Medical Group Senior |
$8.89
|
|
|
HC HIV 1 P24 ANTIGEN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87390
|
| Hospital Charge Code |
900913684
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$155.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.77
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.09
|
| Rate for Payer: Dignity Health Media |
$24.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.06
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$39.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$38.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.24
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Vantage Medical Group Senior |
$24.06
|
|
|
HC HIV 2 ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900913683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$125.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.30
|
| Rate for Payer: Blue Distinction Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.61
|
| Rate for Payer: Blue Shield of California EPN |
$17.92
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Media |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC HIV ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
900913662
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$201.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$201.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.36
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.12
|
| Rate for Payer: Dignity Health Media |
$24.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.08
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.49
|
| Rate for Payer: Heritage Provider Network Transplant |
$39.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$39.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.49
|
| Rate for Payer: Vantage Medical Group Senior |
$24.08
|
|
|
HC HIV RAPID TESTING
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86703
|
| Hospital Charge Code |
900912325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$128.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.93
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.24
|
| Rate for Payer: Blue Shield of California EPN |
$27.14
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Media |
$13.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.08
|
| Rate for Payer: Vantage Medical Group Senior |
$13.71
|
|
|
HC HLA A B C DR DQ MOLECULAR
|
Facility
|
IP
|
$2,395.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$574.80 |
| Max. Negotiated Rate |
$2,035.75 |
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$958.00
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.80
|
| Rate for Payer: Multiplan Commercial |
$1,916.00
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
|
|
HC HLA A B C DR DQ MOLECULAR
|
Facility
|
OP
|
$2,395.00
|
|
|
Service Code
|
CPT 81370
|
| Hospital Charge Code |
903902023
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$325.72 |
| Max. Negotiated Rate |
$2,035.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,945.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$402.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,508.02
|
| Rate for Payer: Blue Distinction Transplant |
$1,437.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,226.24
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cash Price |
$1,077.75
|
| Rate for Payer: Cigna of CA HMO |
$1,532.80
|
| Rate for Payer: Cigna of CA PPO |
$1,772.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.18
|
| Rate for Payer: Dignity Health Media |
$402.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$402.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$402.12
|
| Rate for Payer: Galaxy Health WC |
$2,035.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,437.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,796.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$659.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$659.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$651.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$651.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$402.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,597.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$538.84
|
| Rate for Payer: Multiplan Commercial |
$1,916.00
|
| Rate for Payer: Networks By Design Commercial |
$1,556.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,035.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,437.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,437.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$325.72
|
| Rate for Payer: United Healthcare All Other HMO |
$325.72
|
| Rate for Payer: United Healthcare HMO Rider |
$325.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.33
|
| Rate for Payer: Vantage Medical Group Senior |
$402.12
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
IP
|
$2,330.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$559.20 |
| Max. Negotiated Rate |
$1,980.50 |
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$932.00
|
| Rate for Payer: Galaxy Health WC |
$1,980.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$887.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.20
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: Networks By Design Commercial |
$1,514.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,980.50
|
|
|
HC HLA-A B C HI-RES MOLECULAR
|
Facility
|
OP
|
$2,330.00
|
|
|
Service Code
|
CPT 81379
|
| Hospital Charge Code |
903902022
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$271.66 |
| Max. Negotiated Rate |
$3,417.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,622.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,417.39
|
| Rate for Payer: Blue Distinction Transplant |
$1,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,505.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,192.96
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Cash Price |
$1,048.50
|
| Rate for Payer: Cigna of CA HMO |
$1,491.20
|
| Rate for Payer: Cigna of CA PPO |
$1,724.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.07
|
| Rate for Payer: Dignity Health Media |
$335.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.38
|
| Rate for Payer: Galaxy Health WC |
$1,980.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,398.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,747.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$543.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$543.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,554.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$559.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.41
|
| Rate for Payer: Multiplan Commercial |
$1,864.00
|
| Rate for Payer: Networks By Design Commercial |
$1,514.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,980.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,398.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,398.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.66
|
| Rate for Payer: United Healthcare All Other HMO |
$271.66
|
| Rate for Payer: United Healthcare HMO Rider |
$271.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$271.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.92
|
| Rate for Payer: Vantage Medical Group Senior |
$335.38
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$321.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$321.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$285.81
|
| Rate for Payer: Blue Distinction Transplant |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$59.43
|
| Rate for Payer: Blue Shield of California EPN |
$47.10
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.28
|
| Rate for Payer: Dignity Health Media |
$64.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.19
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$105.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$103.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.01
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.99
|
| Rate for Payer: United Healthcare All Other HMO |
$51.99
|
| Rate for Payer: United Healthcare HMO Rider |
$51.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.61
|
| Rate for Payer: Vantage Medical Group Senior |
$64.19
|
|
|
HC HLA AB SCREEN I/II
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 86828
|
| Hospital Charge Code |
903901995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,083.75 |
| Rate for Payer: Cash Price |
$573.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.00
|
| Rate for Payer: Galaxy Health WC |
$1,083.75
|
| Rate for Payer: Global Benefits Group Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$850.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
| Rate for Payer: Networks By Design Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.75
|
|
|
HC HLA A-C MOLECULAR
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 81372
|
| Hospital Charge Code |
903901902
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$3,256.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,996.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$403.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,256.58
|
| Rate for Payer: Blue Distinction Transplant |
$243.00
|
| Rate for Payer: Blue Shield of California Commercial |
$261.63
|
| Rate for Payer: Blue Shield of California EPN |
$207.36
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.38
|
| Rate for Payer: Dignity Health Media |
$403.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$403.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$403.59
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$303.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$661.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$661.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$653.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$653.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$403.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$540.81
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.91
|
| Rate for Payer: United Healthcare All Other HMO |
$326.91
|
| Rate for Payer: United Healthcare HMO Rider |
$326.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.95
|
| Rate for Payer: Vantage Medical Group Senior |
$403.59
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$529.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.04
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Media |
$58.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$58.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$95.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$95.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$93.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.98
|
| Rate for Payer: United Healthcare All Other HMO |
$46.98
|
| Rate for Payer: United Healthcare HMO Rider |
$46.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC HLA A-C SEROLOGY
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
903901988
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$978.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.73
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
|
HC HLA A MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901985
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.68
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA - B27
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
|
|
HC HLA - B27
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 81373
|
| Hospital Charge Code |
903901903
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$1,102.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$676.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,102.32
|
| Rate for Payer: Blue Distinction Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$91.73
|
| Rate for Payer: Blue Shield of California EPN |
$72.70
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.14
|
| Rate for Payer: Dignity Health Media |
$127.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$127.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$127.43
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$208.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$206.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$127.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.76
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.22
|
| Rate for Payer: United Healthcare All Other HMO |
$103.22
|
| Rate for Payer: United Healthcare HMO Rider |
$103.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.17
|
| Rate for Payer: Vantage Medical Group Senior |
$127.43
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$241.68 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.80
|
| Rate for Payer: Galaxy Health WC |
$855.95
|
| Rate for Payer: Global Benefits Group Commercial |
$604.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$671.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.68
|
| Rate for Payer: Multiplan Commercial |
$805.60
|
| Rate for Payer: Networks By Design Commercial |
$654.55
|
| Rate for Payer: Prime Health Services Commercial |
$855.95
|
|
|
HC HLA B MOLECULAR HI RESOLUTION
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 81380
|
| Hospital Charge Code |
903901989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$978.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$594.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$978.73
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.41
|
| Rate for Payer: Blue Shield of California EPN |
$113.66
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.88
|
| Rate for Payer: Dignity Health Media |
$177.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.29
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$177.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$177.25
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.69
|
| Rate for Payer: Heritage Provider Network Transplant |
$290.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$287.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$177.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.52
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.58
|
| Rate for Payer: United Healthcare All Other HMO |
$143.58
|
| Rate for Payer: United Healthcare HMO Rider |
$143.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.98
|
| Rate for Payer: Vantage Medical Group Senior |
$177.25
|
|
