|
HC I & D HEM SEROMA FL COLL
|
Facility
|
IP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$873.14 |
| Max. Negotiated Rate |
$3,618.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,265.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,265.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
|
|
HC I & D HEM SEROMA FL COLL
|
Facility
|
OP
|
$4,824.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
900501005
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$964.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,314.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.64
|
| Rate for Payer: Blue Shield of California EPN |
$2,354.11
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cash Price |
$2,653.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,135.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,986.06
|
| Rate for Payer: Heritage Provider Network Senior |
$2,986.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$80.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,301.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$873.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,618.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,058.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC I & D OF SCROTUM
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,044.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,237.85
|
| Rate for Payer: Cash Price |
$3,237.85
|
| Rate for Payer: Cash Price |
$3,237.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,826.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Senior |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,602.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,985.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,985.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,808.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,993.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,471.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,279.58
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,118.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,949.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC I & D OF SCROTUM
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
900501592
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,065.55 |
| Max. Negotiated Rate |
$4,415.25 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Cash Price |
$3,237.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,985.50
|
| Rate for Payer: Heritage Provider Network Senior |
$3,985.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,471.75
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$591.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$559.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Senior |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$386.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$410.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$444.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.99
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
| Rate for Payer: Multiplan WC |
$615.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$309.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$285.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC I&D OF VULVA OR PERI ABSC
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
900501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Adventist Health Commercial |
$172.20
|
| Rate for Payer: Cash Price |
$473.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$582.90
|
| Rate for Payer: Heritage Provider Network Senior |
$582.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Multiplan Commercial |
$645.75
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$81.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$104.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.72
|
| Rate for Payer: Blue Shield of California EPN |
$74.18
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$98.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Senior |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$94.09
|
| Rate for Payer: Heritage Provider Network Senior |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$60.80
|
| Rate for Payer: TriValley Medical Group Senior |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$76.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.90
|
| Rate for Payer: Heritage Provider Network Senior |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$999.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$945.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Senior |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,158.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.03
|
| Rate for Payer: Heritage Provider Network Senior |
$985.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$694.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,459.61
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$523.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$481.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.36 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$985.03
|
| Rate for Payer: Heritage Provider Network Senior |
$985.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.75
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$391.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$271.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,210.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,091.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,178.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,178.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,534.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,157.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,065.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$582.46 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,178.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,178.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.50
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Senior |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$893.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$391.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,126.41
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$295.04
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$271.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,160.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,809.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,950.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,850.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$3,850.00
|
| Rate for Payer: Cash Price |
$3,850.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,550.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,950.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,950.00
|
| Rate for Payer: Dignity Health Senior |
$5,950.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,333.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,333.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,339.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,900.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,900.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,950.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,950.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,950.00
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.00 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Cash Price |
$3,850.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,739.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,739.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,750.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
OP
|
$5,622.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,124.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,862.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,092.10
|
| Rate for Payer: Cash Price |
$3,092.10
|
| Rate for Payer: Cash Price |
$3,092.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,654.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,806.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,806.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,681.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$4,216.50
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,022.80
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,861.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$5,622.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,017.58 |
| Max. Negotiated Rate |
$4,216.50 |
| Rate for Payer: Adventist Health Commercial |
$1,124.40
|
| Rate for Payer: Cash Price |
$3,092.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,806.09
|
| Rate for Payer: Heritage Provider Network Senior |
$3,806.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,405.50
|
| Rate for Payer: Multiplan Commercial |
$4,216.50
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,552.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,469.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,469.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,530.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,530.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,078.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$813.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$748.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$409.06 |
| Max. Negotiated Rate |
$1,695.00 |
| Rate for Payer: Adventist Health Commercial |
$452.00
|
| Rate for Payer: Cash Price |
$1,243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,530.02
|
| Rate for Payer: Heritage Provider Network Senior |
$1,530.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.00
|
| Rate for Payer: Multiplan Commercial |
$1,695.00
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$2,885.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$2,163.75 |
| Rate for Payer: Adventist Health Commercial |
$577.00
|
| Rate for Payer: Cash Price |
$1,586.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.25
|
| Rate for Payer: Multiplan Commercial |
$2,163.75
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$2,885.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$577.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,981.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,586.75
|
| Rate for Payer: Cash Price |
$1,586.75
|
| Rate for Payer: Cash Price |
$1,586.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,875.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Senior |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,636.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,376.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$522.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,182.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,582.02
|
| Rate for Payer: Multiplan Commercial |
$2,163.75
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,038.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$955.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$1,616.70 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,016.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,046.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,426.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.22
|
| Rate for Payer: Blue Shield of California EPN |
$928.18
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,616.70
|
| Rate for Payer: Dignity Health Senior |
$1,616.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,236.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$907.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,331.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,331.40
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$951.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,616.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,616.70
|
|
