|
HC LAB REF EASTERN EQUINE AB IGG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900911467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.52
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
HC LAB REF EASTERN EQUINE AB IGG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900911467
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF EASTERN EQUINE AB IGM
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900912653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.52
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.22
|
| Rate for Payer: Heritage Provider Network Senior |
$14.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
|
|
HC LAB REF EASTERN EQUINE AB IGM
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
900912653
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$106.16
|
| Rate for Payer: Blue Shield of California EPN |
$85.15
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.39
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.19
|
| Rate for Payer: TriValley Medical Group Senior |
$13.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC LAB REF ECHINOCOCCUS IGE
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.37
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC LAB REF ECHINOCOCCUS IGE
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A10
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A10
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A16
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A16
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912732
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A2
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A2
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A4
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A4
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A7
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A7
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912729
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A9
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE A9
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B1
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911762
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B1
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900911762
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B2
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B2
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912731
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.88
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B3
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912733
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.59
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.19
|
| Rate for Payer: Heritage Provider Network Senior |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B3
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912733
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
|
HC LAB REF ENTEROVIRUS AB COXSACKIE B4
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
900912734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Shield of California Commercial |
$104.83
|
| Rate for Payer: Blue Shield of California EPN |
$84.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.46
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.03
|
| Rate for Payer: TriValley Medical Group Senior |
$13.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.33
|
| Rate for Payer: Vantage Medical Group Senior |
$13.03
|
|
