|
HC ABDOMEN THREE OR MORE VIEWS
|
Facility
OP
|
$877.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
909074021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.79 |
| Max. Negotiated Rate |
$657.75 |
| Rate for Payer: Adventist Health Commercial |
$175.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$602.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.48
|
| Rate for Payer: Blue Shield of California Commercial |
$138.68
|
| Rate for Payer: Blue Shield of California EPN |
$78.86
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cash Price |
$394.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$570.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$542.86
|
| Rate for Payer: Heritage Provider Network Senior |
$542.86
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$54.79
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$657.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ABDOMEN TWO VIEWS
|
Facility
IP
|
$680.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
909074019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.16
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$460.36
|
| Rate for Payer: Heritage Provider Network Senior |
$460.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
|
|
HC ABDOMEN TWO VIEWS
|
Facility
OP
|
$680.00
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
909074019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.96 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.62
|
| Rate for Payer: Blue Shield of California Commercial |
$119.06
|
| Rate for Payer: Blue Shield of California EPN |
$67.71
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$442.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$420.92
|
| Rate for Payer: Heritage Provider Network Senior |
$420.92
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$46.96
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$189.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| 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 |
$1,276.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$431.95
|
| Rate for Payer: 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 |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| 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 |
$1,546.50
|
| 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 ABD PARACENTESIS W IMAGE GUID
|
Facility
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| 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 |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$993.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| 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 |
$1,546.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$748.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$688.91
|
| 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 ABD PARACENTESIS W IMAG GUID
|
Facility
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$296.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$327.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,124.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.58
|
| Rate for Payer: Blue Shield of California EPN |
$960.92
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,064.05
|
| 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 |
$1,013.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,013.30
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$431.95
|
| Rate for Payer: 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 |
$296.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.25
|
| 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 |
$1,227.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,132.59
|
| 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 ABD PARACENTESIS W IMAG GUID
|
Facility
IP
|
$1,637.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$296.30 |
| Max. Negotiated Rate |
$1,227.75 |
| Rate for Payer: Adventist Health Commercial |
$327.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,124.62
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,108.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,108.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.25
|
| Rate for Payer: Multiplan Commercial |
$1,227.75
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| 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 |
$1,276.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$91.37
|
| Rate for Payer: 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 |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| 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 |
$1,546.50
|
| 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 ABD PARACENTESIS WO IMAGE GUID
|
Facility
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$1,637.25 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,499.72
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,477.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,477.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.75
|
| Rate for Payer: Multiplan Commercial |
$1,637.25
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,499.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,418.95
|
| 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 |
$1,351.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$91.37
|
| Rate for Payer: 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 |
$395.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.75
|
| 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 |
$1,637.25
|
| 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 ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
OP
|
$3,498.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$699.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,403.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,973.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,923.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,623.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,273.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,973.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,973.30
|
| Rate for Payer: Dignity Health Senior |
$2,973.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,165.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,165.26
|
| Rate for Payer: IEHP Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,686.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.50
|
| Rate for Payer: Multiplan Commercial |
$2,623.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,973.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,973.30
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
IP
|
$3,498.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.14 |
| Max. Negotiated Rate |
$2,623.50 |
| Rate for Payer: Adventist Health Commercial |
$699.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,403.13
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,368.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,368.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.50
|
| Rate for Payer: Multiplan Commercial |
$2,623.50
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
IP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.43 |
| Max. Negotiated Rate |
$1,688.25 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,546.44
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,523.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.75
|
| Rate for Payer: Multiplan Commercial |
$1,688.25
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
OP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,546.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,913.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,238.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,688.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,463.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,913.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,913.35
|
| Rate for Payer: Dignity Health Senior |
$1,913.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,393.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.37
|
| Rate for Payer: IEHP Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,084.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.75
|
| Rate for Payer: Multiplan Commercial |
$1,688.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,913.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,913.35
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
IP
|
$2,764.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.28 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,871.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,871.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$523.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.30
|
| Rate for Payer: Heritage Provider Network Senior |
$498.30
|
| Rate for Payer: IEHP Medi-Cal |
$379.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
OP
|
$2,764.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,349.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,520.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,073.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,796.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,349.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,349.40
|
| Rate for Payer: Dignity Health Senior |
$2,349.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,710.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,710.92
|
| Rate for Payer: IEHP Medi-Cal |
$379.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,332.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,349.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,349.40
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
OP
|
$3,075.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$615.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,112.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,613.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,691.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,306.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,998.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,613.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,613.75
|
| Rate for Payer: Dignity Health Senior |
$2,613.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,903.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,903.42
|
| Rate for Payer: IEHP Medi-Cal |
$451.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,482.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$2,306.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,613.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,613.75
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
IP
|
$3,075.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$556.58 |
| Max. Negotiated Rate |
$2,306.25 |
| Rate for Payer: Adventist Health Commercial |
$615.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,112.52
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$2,306.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
IP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
OP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$523.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.30
|
| Rate for Payer: Heritage Provider Network Senior |
$498.30
|
| Rate for Payer: IEHP Medi-Cal |
$451.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
