|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$606.00 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.10
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$547.02
|
| Rate for Payer: Heritage Provider Network Senior |
$547.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
|
|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$686.80 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$431.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$555.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Blue Shield of California Commercial |
$501.77
|
| Rate for Payer: Blue Shield of California EPN |
$474.30
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$525.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Senior |
$686.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$525.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.15
|
| Rate for Payer: Heritage Provider Network Senior |
$500.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$389.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
IP
|
$5,180.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$3,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,558.66
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,506.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,506.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
OP
|
$5,180.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$4,403.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,768.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,558.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,849.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,216.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,040.66
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,367.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,403.00
|
| Rate for Payer: Dignity Health Senior |
$4,403.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,367.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,206.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,206.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,496.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,403.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,403.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
OP
|
$5,180.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$4,403.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,768.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,558.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,849.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,216.78
|
| Rate for Payer: Blue Shield of California EPN |
$3,040.66
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,367.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,403.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,403.00
|
| Rate for Payer: Dignity Health Senior |
$4,403.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,367.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,206.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,206.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,496.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,403.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,403.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
IP
|
$5,180.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$937.58 |
| Max. Negotiated Rate |
$3,885.00 |
| Rate for Payer: Adventist Health Commercial |
$1,036.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,558.66
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,506.86
|
| Rate for Payer: Heritage Provider Network Senior |
$3,506.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$937.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,295.00
|
| Rate for Payer: Multiplan Commercial |
$3,885.00
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
OP
|
$1,195.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$1,015.75 |
| Rate for Payer: Adventist Health Commercial |
$239.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$638.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$657.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.25
|
| Rate for Payer: Blue Shield of California Commercial |
$742.10
|
| Rate for Payer: Blue Shield of California EPN |
$701.46
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$776.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,015.75
|
| Rate for Payer: Dignity Health Senior |
$1,015.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$739.70
|
| Rate for Payer: Heritage Provider Network Senior |
$739.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$575.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.75
|
| Rate for Payer: Multiplan Commercial |
$896.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,015.75
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
IP
|
$1,195.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$896.25 |
| Rate for Payer: Adventist Health Commercial |
$239.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.96
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$809.02
|
| Rate for Payer: Heritage Provider Network Senior |
$809.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.75
|
| Rate for Payer: Multiplan Commercial |
$896.25
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.97
|
| Rate for Payer: Heritage Provider Network Senior |
$41.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$32.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.50
|
| Rate for Payer: Blue Shield of California EPN |
$36.39
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.38
|
| Rate for Payer: Heritage Provider Network Senior |
$38.38
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$175.56
|
| Rate for Payer: TriValley Medical Group Senior |
$159.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Adventist Health Commercial |
$77.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.56
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$262.68
|
| Rate for Payer: Heritage Provider Network Senior |
$262.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Adventist Health Commercial |
$77.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$266.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.39
|
| Rate for Payer: Blue Shield of California Commercial |
$106.71
|
| Rate for Payer: Blue Shield of California EPN |
$83.42
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$252.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Senior |
$13.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$240.17
|
| Rate for Payer: Heritage Provider Network Senior |
$240.17
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$25.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.24
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
IP
|
$11,134.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,015.25 |
| Max. Negotiated Rate |
$8,350.50 |
| Rate for Payer: Adventist Health Commercial |
$2,226.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,649.06
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,537.72
|
| Rate for Payer: Heritage Provider Network Senior |
$7,537.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,015.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.50
|
| Rate for Payer: Multiplan Commercial |
$8,350.50
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
OP
|
$11,134.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,582.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,226.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,649.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cash Price |
$5,010.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,237.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,891.95
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,582.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,015.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,783.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$8,350.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
IP
|
$10,563.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,911.90 |
| Max. Negotiated Rate |
$7,922.25 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,256.78
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,151.15
|
| Rate for Payer: Heritage Provider Network Senior |
$7,151.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.75
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
OP
|
$10,563.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.52 |
| Max. Negotiated Rate |
$17,960.09 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,256.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,397.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,452.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,865.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,397.95
|
| Rate for Payer: Dignity Health Senior |
$9,452.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,452.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,538.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11,626.80
|
| Rate for Payer: Humana Medicare |
$9,452.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,452.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,960.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,154.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,910.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,910.38
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
| Rate for Payer: Multiplan WC |
$12,923.16
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,397.95
|
| Rate for Payer: TriValley Medical Group Senior |
$10,397.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,179.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,397.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9,452.68
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.02 |
| Max. Negotiated Rate |
$1,902.00 |
| Rate for Payer: Adventist Health Commercial |
$507.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.23
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,716.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,716.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.00
|
| Rate for Payer: Multiplan Commercial |
$1,902.00
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$507.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,742.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cash Price |
$1,141.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,648.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,569.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$575.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,902.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC BILIARY COPE LOOP CATH
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$192.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$282.99
|
| Rate for Payer: Heritage Provider Network Senior |
$282.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.50
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$152.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.65
|
|
|
HC BILIARY COPE LOOP CATH
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$200.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$259.58
|
| Rate for Payer: Blue Shield of California EPN |
$245.37
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$192.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Senior |
$355.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$193.53
|
| Rate for Payer: Heritage Provider Network Senior |
$193.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.50
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$152.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$139.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
|
HC BILIARY DILATION WITH STENT
|
Facility
|
IP
|
$20,385.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
909000150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,689.68 |
| Max. Negotiated Rate |
$15,288.75 |
| Rate for Payer: Adventist Health Commercial |
$4,077.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,004.50
|
| Rate for Payer: Cash Price |
$9,173.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,800.64
|
| Rate for Payer: Heritage Provider Network Senior |
$13,800.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,689.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,096.25
|
| Rate for Payer: Multiplan Commercial |
$15,288.75
|
|
|
HC BILIARY DILATION WITH STENT
|
Facility
|
OP
|
$20,385.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
909000150
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$536.66 |
| Max. Negotiated Rate |
$24,436.49 |
| Rate for Payer: Adventist Health Commercial |
$4,077.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,004.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$9,173.25
|
| Rate for Payer: Cash Price |
$9,173.25
|
| Rate for Payer: Cash Price |
$9,173.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,250.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: Dignity Health Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$12,861.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,618.32
|
| Rate for Payer: Heritage Provider Network Senior |
$15,819.41
|
| Rate for Payer: Humana Medicare |
$12,861.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$536.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24,436.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,689.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,176.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,096.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,205.25
|
| Rate for Payer: Multiplan Commercial |
$15,288.75
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,147.44
|
| Rate for Payer: TriValley Medical Group Senior |
$14,147.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC BILIARY DILATION W/O STENT
|
Facility
|
OP
|
$10,563.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$360.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,256.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,865.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,538.50
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$360.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC BILIARY DILATION W/O STENT
|
Facility
|
IP
|
$10,563.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
909000149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,911.90 |
| Max. Negotiated Rate |
$7,922.25 |
| Rate for Payer: Adventist Health Commercial |
$2,112.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,256.78
|
| Rate for Payer: Cash Price |
$4,753.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,151.15
|
| Rate for Payer: Heritage Provider Network Senior |
$7,151.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,911.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,640.75
|
| Rate for Payer: Multiplan Commercial |
$7,922.25
|
|
|
HC BILIARY DRAINAGE CATH CHANGE
|
Facility
|
OP
|
$7,242.00
|
|
|
Service Code
|
CPT 47536
|
| Hospital Charge Code |
909000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,448.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,975.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cash Price |
$3,258.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,707.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,902.83
|
| Rate for Payer: Heritage Provider Network Senior |
$4,902.83
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,490.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,310.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,810.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$5,431.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,629.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,419.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
