|
HC ESOPH LESION ABLATION
|
Facility
|
OP
|
$3,967.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$793.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,725.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,181.85
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Cash Price |
$2,181.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,578.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Senior |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,834.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.57
|
| Rate for Payer: Heritage Provider Network Senior |
$5,945.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$290.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,892.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$718.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,559.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,090.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,090.89
|
| Rate for Payer: Multiplan Commercial |
$2,975.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$751.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$965.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.50
|
| 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 |
$773.30
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$913.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,195.10
|
| Rate for Payer: Dignity Health Senior |
$1,195.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$843.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$870.31
|
| Rate for Payer: Heritage Provider Network Senior |
$870.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$670.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$984.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.20
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,195.10
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$773.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$951.86
|
| Rate for Payer: Heritage Provider Network Senior |
$951.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,696.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| 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 |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,605.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Senior |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$674.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,528.93
|
| Rate for Payer: Heritage Provider Network Senior |
$829.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,178.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.47
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.50
|
| Rate for Payer: Multiplan Commercial |
$1,852.50
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$984.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$525.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$676.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.47
|
| Rate for Payer: Blue Shield of California Commercial |
$249.02
|
| Rate for Payer: Blue Shield of California EPN |
$200.26
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$639.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$639.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$609.10
|
| Rate for Payer: Heritage Provider Network Senior |
$609.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$469.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$984.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Cash Price |
$541.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$666.17
|
| Rate for Payer: Heritage Provider Network Senior |
$666.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$738.00
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$2,153.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$389.69 |
| Max. Negotiated Rate |
$1,614.75 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,457.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,457.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,153.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$430.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,479.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,184.15
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Cash Price |
$1,184.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,399.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,332.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,026.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$389.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$1,614.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| 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 |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$5,039.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$912.06 |
| Max. Negotiated Rate |
$3,779.25 |
| Rate for Payer: Adventist Health Commercial |
$1,007.80
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,411.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3,411.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.75
|
| Rate for Payer: Multiplan Commercial |
$3,779.25
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$5,039.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,345.46 |
| Rate for Payer: Adventist Health Commercial |
$1,007.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,461.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,771.45
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cash Price |
$2,771.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,275.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Senior |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,563.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,119.14
|
| Rate for Payer: Heritage Provider Network Senior |
$9,303.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,403.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$912.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,698.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,779.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,984.12 |
| Max. Negotiated Rate |
$8,221.50 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,421.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,421.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,984.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,740.50
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$9,317.70 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,859.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,530.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,029.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,221.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Cash Price |
$6,029.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,125.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,317.70
|
| Rate for Payer: Dignity Health Senior |
$9,317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,125.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,421.27
|
| Rate for Payer: Heritage Provider Network Senior |
$7,421.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,228.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,984.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,740.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,673.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,673.40
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,944.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,629.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,317.70
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$252.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$236.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$252.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Cash Price |
$260.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$292.79
|
| Rate for Payer: Heritage Provider Network Senior |
$292.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$225.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$236.50
|
| Rate for Payer: TriValley Medical Group Senior |
$236.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$236.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$236.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$245.61 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$179.34
|
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$245.61 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$157.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$201.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$179.34
|
| Rate for Payer: Blue Shield of California EPN |
$143.47
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.99
|
| Rate for Payer: Heritage Provider Network Senior |
$181.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$140.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$58.80
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$199.04
|
| Rate for Payer: Heritage Provider Network Senior |
$199.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$245.61 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Blue Shield of California EPN |
$93.70
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.98
|
| Rate for Payer: Heritage Provider Network Senior |
$129.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$102.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$131.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Blue Shield of California EPN |
$93.70
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,224.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$118.85
|
| Rate for Payer: Heritage Provider Network Senior |
$118.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$91.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$180.11
|
| Rate for Payer: TriValley Medical Group Senior |
$180.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$96.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$96.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
