|
HC BRAIN IMAGE 4+ VIEWS
|
Facility
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 78605
|
| Hospital Charge Code |
909301410
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.69 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$379.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$792.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$693.97
|
| Rate for Payer: Blue Shield of California EPN |
$394.64
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$749.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$713.71
|
| Rate for Payer: Heritage Provider Network Senior |
$713.71
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$209.23
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
IP
|
$2,312.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$418.47 |
| Max. Negotiated Rate |
$1,734.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,588.34
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,565.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,565.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
|
|
HC BRAIN IMAGE 4+ VIEWS W FLOW
|
Facility
OP
|
$2,312.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
909301411
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.32 |
| Max. Negotiated Rate |
$1,734.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$651.61
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,588.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$790.34
|
| Rate for Payer: Blue Shield of California EPN |
$449.44
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,502.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,431.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,431.13
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$248.32
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
IP
|
$5,440.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$984.64 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,737.28
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,682.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3,682.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
|
|
HC BREAST BX PERCUT,OPEN INCISION
|
Facility
OP
|
$5,440.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
900501729
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,088.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,737.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,536.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,682.88
|
| Rate for Payer: Heritage Provider Network Senior |
$3,682.88
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,622.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,360.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,975.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,817.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
OP
|
$627.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$532.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$344.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$470.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$407.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$532.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$532.95
|
| Rate for Payer: Dignity Health Senior |
$532.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.11
|
| Rate for Payer: Heritage Provider Network Senior |
$388.11
|
| Rate for Payer: IEHP Medi-Cal |
$32.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
| 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 |
$532.95
|
| Rate for Payer: Vantage Medical Group Senior |
$532.95
|
|
|
HC BREAST CYST ASPIR, ADDL
|
Facility
IP
|
$627.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
909000102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$470.25 |
| Rate for Payer: Adventist Health Commercial |
$125.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$430.75
|
| Rate for Payer: Cash Price |
$282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.48
|
| Rate for Payer: Heritage Provider Network Senior |
$424.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$470.25
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$695.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$515.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$388.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$357.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$802.50 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.39
|
| Rate for Payer: Heritage Provider Network Senior |
$724.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
|
|
HC BREAST CYST ASPIR INITIAL
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
909000101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$735.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cash Price |
$481.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$695.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$662.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$802.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
IP
|
$1,900.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.30
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,286.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
|
|
HC BREAST LOCALIZATION DEVICE MRI
|
Facility
OP
|
$1,900.00
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
908819287
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$185.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$380.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,305.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,179.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,115.30
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cash Price |
$855.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$185.27
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
IP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$767.44 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Adventist Health Commercial |
$848.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.88
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,870.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,870.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.00
|
| Rate for Payer: Multiplan Commercial |
$3,180.00
|
|
|
HC BREAST LOCALIZATION DEVICE STEREOTACTIC GUIDANCE
|
Facility
OP
|
$4,240.00
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
909019283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$381.58 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$848.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,912.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,756.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,624.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$381.58
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$767.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,060.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$3,180.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
IP
|
$1,573.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.71 |
| Max. Negotiated Rate |
$1,179.75 |
| Rate for Payer: Adventist Health Commercial |
$314.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.65
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,064.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,064.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.25
|
| Rate for Payer: Multiplan Commercial |
$1,179.75
|
|
|
HC BREAST LOCALIZATION DEVICE US GUIDANCE
|
Facility
OP
|
$1,573.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
906619285
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$314.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,080.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$976.83
|
| Rate for Payer: Blue Shield of California EPN |
$923.35
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cash Price |
$707.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,022.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$973.69
|
| Rate for Payer: Heritage Provider Network Senior |
$973.69
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$742.83
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$1,179.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$879.07
|
| Rate for Payer: TriValley Medical Group Senior |
$879.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$394.40 |
| Max. Negotiated Rate |
$1,634.25 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,496.97
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,475.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,475.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.75
|
| Rate for Payer: Multiplan Commercial |
$1,634.25
|
|
|
HC BREAST LOCALIZATION DEVICE W MAMMO GUIDANCE
|
Facility
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
909019281
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$336.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,496.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,353.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,279.07
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,416.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,348.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.80
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$336.85
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$544.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$1,634.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,025.69
|
| Rate for Payer: TriValley Medical Group Senior |
$2,025.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC BREAST TOMO
|
Facility
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,039.25
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: Dignity Health Senior |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,767.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,683.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,683.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO
|
Facility
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002014
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,840.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,840.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
|
|
HC BREAST TOMO COMBO
|
Facility
OP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$407.25 |
| Max. Negotiated Rate |
$2,311.15 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,311.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,495.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,039.25
|
| Rate for Payer: Blue Shield of California Commercial |
$716.15
|
| Rate for Payer: Blue Shield of California EPN |
$407.25
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,767.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,311.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,311.15
|
| Rate for Payer: Dignity Health Senior |
$2,311.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,767.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,683.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,683.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,310.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,311.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,311.15
|
|
|
HC BREAST TOMO COMBO
|
Facility
IP
|
$2,719.00
|
|
|
Service Code
|
CPT 76377
|
| Hospital Charge Code |
909002017
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Adventist Health Commercial |
$543.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,867.95
|
| Rate for Payer: Cash Price |
$1,223.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,840.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,840.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$679.75
|
| Rate for Payer: Multiplan Commercial |
$2,039.25
|
|
|
HC BRISK PROFILE
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$93.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$321.52
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.84
|
| Rate for Payer: Heritage Provider Network Senior |
$316.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$351.00
|
|
|
HC BRISK PROFILE
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$167.76 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.77
|
| Rate for Payer: Blue Shield of California Commercial |
$167.76
|
| Rate for Payer: Blue Shield of California EPN |
$131.14
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Senior |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$24.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Humana Medicare |
$24.91
|
| Rate for Payer: IEHP Medi-Cal |
$18.56
|
| Rate for Payer: IEHP Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$47.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$24.91
|
| Rate for Payer: TriValley Medical Group Senior |
$24.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$26.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
