|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF SHORT ARM SPLINT
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
900501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$301.15
|
| Rate for Payer: Blue Shield of California EPN |
$239.65
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: TriValley Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Senior |
$380.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$146.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.35
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Adventist Health Commercial |
$61.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$198.35
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$208.52
|
| Rate for Payer: Heritage Provider Network Senior |
$208.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$190.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$200.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$171.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.65
|
| Rate for Payer: Heritage Provider Network Senior |
$190.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$146.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$286.90
|
| Rate for Payer: Blue Shield of California EPN |
$228.31
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Senior |
$362.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$286.90
|
| Rate for Payer: Blue Shield of California EPN |
$228.31
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Senior |
$362.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$566.25 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.22
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.13
|
| Rate for Payer: Heritage Provider Network Senior |
$511.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.75
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
|
|
HC APP SHORT LEG SPLINT
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
900501107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$151.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$466.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$358.62
|
| Rate for Payer: Blue Shield of California EPN |
$285.39
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cash Price |
$339.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.13
|
| Rate for Payer: Heritage Provider Network Senior |
$511.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$360.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$566.25
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$453.00
|
| Rate for Payer: TriValley Medical Group Senior |
$453.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
OP
|
$5,286.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,057.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,266.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,378.70
|
| Rate for Payer: Cash Price |
$2,378.70
|
| Rate for Payer: Cash Price |
$2,378.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,435.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,272.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,806.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$956.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,964.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,045.63
|
| Rate for Payer: TriValley Medical Group Senior |
$1,045.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC APP SKN SUB GRFT FRST 25 SQ CM
|
Facility
|
IP
|
$5,286.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
902315271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$956.77 |
| Max. Negotiated Rate |
$3,964.50 |
| Rate for Payer: Adventist Health Commercial |
$1,057.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,404.18
|
| Rate for Payer: Cash Price |
$2,378.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,578.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,578.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$956.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.50
|
| Rate for Payer: Multiplan Commercial |
$3,964.50
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC APP SURFACE NEUROSTIMULATOR MCAL
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901300019
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$110.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$166.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$202.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$175.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.13
|
| Rate for Payer: Heritage Provider Network Senior |
$167.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$128.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$292.80
|
| Rate for Payer: Blue Shield of California EPN |
$234.24
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$312.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.12
|
| Rate for Payer: Heritage Provider Network Senior |
$297.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$228.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.90
|
| Rate for Payer: TriValley Medical Group Senior |
$229.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$240.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$240.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC APP VENOUS WOUND COMP SYS KNEE
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
950420022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.12
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$108.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$44.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$70.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$91.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$91.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.85
|
| Rate for Payer: Heritage Provider Network Senior |
$66.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$51.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$91.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$91.80
|
| Rate for Payer: Vantage Medical Group Senior |
$91.80
|
|
