|
HC ECG TRACING ONLY
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
906593005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$532.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.67
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.96
|
| Rate for Payer: Heritage Provider Network Senior |
$532.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$410.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
906593005
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.48
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
|
|
HC ECG TRACING ONLY
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$532.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.67
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.99
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.96
|
| Rate for Payer: Heritage Provider Network Senior |
$532.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$410.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900200101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.48
|
| Rate for Payer: Cash Price |
$387.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$155.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.70
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY RSPC CH
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100039
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.70
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY RSPC EC
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100037
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC ECG TRACING ONLY RSPC HSH
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100040
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.70
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$626.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.70
|
| Rate for Payer: Blue Shield of California Commercial |
$93.79
|
| Rate for Payer: Blue Shield of California EPN |
$75.42
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$658.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$597.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$627.05
|
| Rate for Payer: Heritage Provider Network Senior |
$627.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$483.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$83.46
|
| Rate for Payer: TriValley Medical Group Senior |
$75.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$390.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ECG TRACING ONLY RSPC MC
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
900100038
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$183.35 |
| Max. Negotiated Rate |
$759.75 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.37
|
| Rate for Payer: Cash Price |
$455.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.80
|
| Rate for Payer: Heritage Provider Network Senior |
$685.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.25
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
|
OP
|
$3,453.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$334.39 |
| Max. Negotiated Rate |
$2,589.75 |
| Rate for Payer: Adventist Health Commercial |
$690.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,133.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,727.19
|
| Rate for Payer: Blue Shield of California Commercial |
$415.82
|
| Rate for Payer: Blue Shield of California EPN |
$334.39
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,244.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,037.27
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,137.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,137.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,647.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$624.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$2,589.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$702.78
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$353.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$353.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC ECHO-C FETAL 2D COMPLETE
|
Facility
|
IP
|
$3,453.00
|
|
|
Service Code
|
CPT 76825
|
| Hospital Charge Code |
900200231
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$624.99 |
| Max. Negotiated Rate |
$2,589.75 |
| Rate for Payer: Adventist Health Commercial |
$690.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,223.73
|
| Rate for Payer: Cash Price |
$1,553.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,337.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,337.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$624.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.25
|
| Rate for Payer: Multiplan Commercial |
$2,589.75
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
|
OP
|
$2,258.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$1,693.50 |
| Rate for Payer: Adventist Health Commercial |
$451.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,395.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,129.45
|
| Rate for Payer: Blue Shield of California Commercial |
$366.82
|
| Rate for Payer: Blue Shield of California EPN |
$294.98
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,467.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,332.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,397.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,397.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,077.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,693.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ECHO-C FETAL DOPPLER COMPLETE
|
Facility
|
IP
|
$2,258.00
|
|
|
Service Code
|
CPT 76827
|
| Hospital Charge Code |
900200233
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$408.70 |
| Max. Negotiated Rate |
$1,693.50 |
| Rate for Payer: Adventist Health Commercial |
$451.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,454.15
|
| Rate for Payer: Cash Price |
$1,016.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,528.67
|
| Rate for Payer: Heritage Provider Network Senior |
$1,528.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.50
|
| Rate for Payer: Multiplan Commercial |
$1,693.50
|
|
|
HC ECHO CONTRAST DEFINITY
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
912000220
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$383.18
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.81
|
| Rate for Payer: Heritage Provider Network Senior |
$402.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
|
|
HC ECHO CONTRAST DEFINITY
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT Q9957
|
| Hospital Charge Code |
912000220
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$107.69 |
| Max. Negotiated Rate |
$505.75 |
| Rate for Payer: Adventist Health Commercial |
$119.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$367.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$446.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.05
|
| Rate for Payer: Blue Shield of California Commercial |
$362.95
|
| Rate for Payer: Blue Shield of California EPN |
$290.36
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cash Price |
$267.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$386.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$368.31
|
| Rate for Payer: Heritage Provider Network Senior |
$368.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$283.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$416.50
|
| Rate for Payer: Multiplan Commercial |
$446.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$238.00
|
| Rate for Payer: TriValley Medical Group Senior |
$238.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$297.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$297.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.75
|
| Rate for Payer: Vantage Medical Group Senior |
$505.75
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.63
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.95
|
| Rate for Payer: Heritage Provider Network Senior |
$498.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
|
|
HC ECHO CONTRAST OPTISON
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT Q9956
|
| Hospital Charge Code |
912000219
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$103.54 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: Adventist Health Commercial |
$147.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$455.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$552.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.54
|
| Rate for Payer: Blue Shield of California Commercial |
$449.57
|
| Rate for Payer: Blue Shield of California EPN |
$359.66
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$479.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.20
|
| Rate for Payer: Heritage Provider Network Senior |
$456.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$351.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$515.90
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.80
|
| Rate for Payer: TriValley Medical Group Senior |
$294.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$368.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
|
OP
|
$1,962.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$121.13 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,212.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$981.39
|
| Rate for Payer: Blue Shield of California Commercial |
$150.62
|
| Rate for Payer: Blue Shield of California EPN |
$121.13
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,275.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,157.58
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,214.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,214.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$935.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$353.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$353.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC ECHO-F FETAL 2D F/U
|
Facility
|
IP
|
$1,962.00
|
|
|
Service Code
|
CPT 76826
|
| Hospital Charge Code |
900200232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$355.12 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,263.53
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,328.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,328.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$355.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.50
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
|
|
HC ECHO-F FETAL DOPPLER F/U
|
Facility
|
OP
|
$1,774.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$1,330.50 |
| Rate for Payer: Adventist Health Commercial |
$354.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,096.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$887.35
|
| Rate for Payer: Blue Shield of California Commercial |
$237.79
|
| Rate for Payer: Blue Shield of California EPN |
$191.22
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,153.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,098.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$846.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,330.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$100.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ECHO-F FETAL DOPPLER F/U
|
Facility
|
IP
|
$1,774.00
|
|
|
Service Code
|
CPT 76828
|
| Hospital Charge Code |
900200234
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.09 |
| Max. Negotiated Rate |
$1,330.50 |
| Rate for Payer: Adventist Health Commercial |
$354.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,142.46
|
| Rate for Payer: Cash Price |
$798.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,201.00
|
| Rate for Payer: Heritage Provider Network Senior |
$1,201.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.50
|
| Rate for Payer: Multiplan Commercial |
$1,330.50
|
|
|
HC ECHO PLACEMENT TEE PROBE ONLY
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
906813313
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$41.07 |
| Max. Negotiated Rate |
$1,054.17 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$723.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.23
|
| Rate for Payer: Blue Shield of California Commercial |
$51.07
|
| Rate for Payer: Blue Shield of California EPN |
$41.07
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$760.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$702.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$724.23
|
| Rate for Payer: Heritage Provider Network Senior |
$724.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$558.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$773.06
|
| Rate for Payer: TriValley Medical Group Senior |
$702.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$313.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
