|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$210.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$103.05
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.55
|
| Rate for Payer: Heritage Provider Network Senior |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$43.28 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$15.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.42
|
| Rate for Payer: Blue Shield of California EPN |
$31.60
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: IEHP Medi-Cal |
$7.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
OP
|
$5,640.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,794.00 |
| Rate for Payer: Adventist Health Commercial |
$1,128.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,874.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,794.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,102.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,230.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cash Price |
$2,538.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,794.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,794.00
|
| Rate for Payer: Dignity Health Senior |
$4,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$517.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,718.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,410.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,794.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,794.00
|
|
|
HC MR ANGIO ABD W/O CONTRAST
|
Facility
IP
|
$4,176.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801089
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$755.86 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Adventist Health Commercial |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.91
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,827.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,827.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$755.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,132.00
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
OP
|
$5,295.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,500.75 |
| Rate for Payer: Adventist Health Commercial |
$1,059.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,637.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,500.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,912.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,971.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cash Price |
$2,382.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,500.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,500.75
|
| Rate for Payer: Dignity Health Senior |
$4,500.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$514.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,552.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,323.75
|
| Rate for Payer: Multiplan Commercial |
$3,971.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,500.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,500.75
|
|
|
HC MR ANGIO CHEST W CONTRAST
|
Facility
IP
|
$5,420.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801090
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: Adventist Health Commercial |
$1,084.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,723.54
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,669.34
|
| Rate for Payer: Heritage Provider Network Senior |
$3,669.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.00
|
| Rate for Payer: Multiplan Commercial |
$4,065.00
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
OP
|
$4,919.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$4,181.15 |
| Rate for Payer: Adventist Health Commercial |
$983.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,379.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,181.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,705.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,689.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cash Price |
$2,213.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,181.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,181.15
|
| Rate for Payer: Dignity Health Senior |
$4,181.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$514.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,370.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$890.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.75
|
| Rate for Payer: Multiplan Commercial |
$3,689.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$693.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$693.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,181.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,181.15
|
|
|
HC MR ANGIO CHEST W/O CONTRAST
|
Facility
IP
|
$4,065.00
|
|
|
Service Code
|
CPT 71555
|
| Hospital Charge Code |
908801091
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$735.76 |
| Max. Negotiated Rate |
$3,048.75 |
| Rate for Payer: Adventist Health Commercial |
$813.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,792.66
|
| Rate for Payer: Cash Price |
$1,829.25
|
| Rate for Payer: Cash Price |
$1,829.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,752.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,752.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,016.25
|
| Rate for Payer: Multiplan Commercial |
$3,048.75
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
IP
|
$7,055.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,291.25 |
| Rate for Payer: Adventist Health Commercial |
$1,411.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,846.78
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,776.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,776.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.75
|
| Rate for Payer: Multiplan Commercial |
$5,291.25
|
|
|
HC MR ANGIO LOW EXT W CONTRAST
|
Facility
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801092
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,762.10 |
| Rate for Payer: Adventist Health Commercial |
$885.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,040.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,762.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,434.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,319.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,991.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,762.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,762.10
|
| Rate for Payer: Dignity Health Senior |
$3,762.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$514.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,133.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,106.50
|
| Rate for Payer: Multiplan Commercial |
$3,319.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,762.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,762.10
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
IP
|
$7,055.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,291.25 |
| Rate for Payer: Adventist Health Commercial |
$1,411.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,846.78
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: Cash Price |
$3,174.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,776.24
|
| Rate for Payer: Heritage Provider Network Senior |
$4,776.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,276.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,763.75
|
| Rate for Payer: Multiplan Commercial |
$5,291.25
|
|
|
HC MR ANGIO LOW EXT WO CONT
|
Facility
OP
|
$4,048.00
|
|
|
Service Code
|
CPT 73725
|
| Hospital Charge Code |
908801094
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,440.80 |
| Rate for Payer: Adventist Health Commercial |
$809.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$814.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,780.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,440.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,226.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,036.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cash Price |
$1,821.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,440.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,440.80
|
| Rate for Payer: Dignity Health Senior |
$3,440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$514.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,951.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$732.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.00
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,440.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,440.80
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,635.85 |
| Rate for Payer: Adventist Health Commercial |
$620.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,130.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,635.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,705.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,325.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cash Price |
$1,395.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,635.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,635.85
|
| Rate for Payer: Dignity Health Senior |
$2,635.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,494.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.25
|
| Rate for Payer: Multiplan Commercial |
$2,325.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,635.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,635.85
|
|
|
HC MR ANGIO PELVIS W/CONT
|
Facility
IP
|
$6,923.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801097
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,192.25 |
| Rate for Payer: Adventist Health Commercial |
$1,384.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,756.10
|
| Rate for Payer: Cash Price |
$3,115.35
|
| Rate for Payer: Cash Price |
$3,115.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,686.87
|
| Rate for Payer: Heritage Provider Network Senior |
$4,686.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,253.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,730.75
|
| Rate for Payer: Multiplan Commercial |
$5,192.25
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
IP
|
$5,748.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$4,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,149.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,948.88
|
| Rate for Payer: Cash Price |
$2,586.60
|
| Rate for Payer: Cash Price |
$2,586.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,891.40
|
| Rate for Payer: Heritage Provider Network Senior |
$3,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,040.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,437.00
|
| Rate for Payer: Multiplan Commercial |
$4,311.00
|
|
|
HC MR ANGIO PELVIS WO CONT
|
Facility
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801098
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,316.25 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,043.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: Dignity Health Senior |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
IP
|
$7,081.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,310.75 |
| Rate for Payer: Adventist Health Commercial |
$1,416.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,864.65
|
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: Cash Price |
$3,186.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,793.84
|
| Rate for Payer: Heritage Provider Network Senior |
$4,793.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,281.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,770.25
|
| Rate for Payer: Multiplan Commercial |
$5,310.75
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801099
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,958.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,390.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,610.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: Dignity Health Senior |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,677.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,958.00 |
| Rate for Payer: Adventist Health Commercial |
$696.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,390.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,958.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,914.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,610.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cash Price |
$1,566.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,958.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,958.00
|
| Rate for Payer: Dignity Health Senior |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$516.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,677.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$629.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.00
|
| Rate for Payer: Multiplan Commercial |
$2,610.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$696.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,958.00
|
|
|
HC MR ANGIO PELVIS WO FOL W CONT
|
Facility
IP
|
$7,270.00
|
|
|
Service Code
|
CPT 72198
|
| Hospital Charge Code |
908801034
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$5,452.50 |
| Rate for Payer: Adventist Health Commercial |
$1,454.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,994.49
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: Cash Price |
$3,271.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,921.79
|
| Rate for Payer: Heritage Provider Network Senior |
$4,921.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,817.50
|
| Rate for Payer: Multiplan Commercial |
$5,452.50
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
IP
|
$4,176.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$755.86 |
| Max. Negotiated Rate |
$3,132.00 |
| Rate for Payer: Adventist Health Commercial |
$835.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,868.91
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: Cash Price |
$1,879.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,827.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,827.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$755.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.00
|
| Rate for Payer: Multiplan Commercial |
$3,132.00
|
|
|
HC MR ANGIO W/O FOL W/CONT, ABD
|
Facility
OP
|
$6,378.00
|
|
|
Service Code
|
CPT 74185
|
| Hospital Charge Code |
908801096
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$5,421.30 |
| Rate for Payer: Adventist Health Commercial |
$1,275.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,381.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,421.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,507.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,783.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,286.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cash Price |
$2,870.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,421.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,421.30
|
| Rate for Payer: Dignity Health Senior |
$5,421.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: IEHP Medi-Cal |
$517.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,074.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,594.50
|
| Rate for Payer: Multiplan Commercial |
$4,783.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$694.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$694.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,421.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,421.30
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
IP
|
$5,299.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$929.00 |
| Max. Negotiated Rate |
$3,974.25 |
| Rate for Payer: Adventist Health Commercial |
$1,059.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,640.41
|
| Rate for Payer: Cash Price |
$2,384.55
|
| Rate for Payer: Cash Price |
$2,384.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,587.42
|
| Rate for Payer: Heritage Provider Network Senior |
$3,587.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$959.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.75
|
| Rate for Payer: Multiplan Commercial |
$3,974.25
|
|
|
HC MRI ABDOMEN W/CONTRAST
|
Facility
OP
|
$4,442.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
908801301
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$3,331.50 |
| Rate for Payer: Adventist Health Commercial |
$888.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,574.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,051.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,718.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,545.85
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cash Price |
$1,998.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,075.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: Dignity Health Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,038.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$480.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$955.00
|
| Rate for Payer: Heritage Provider Network Senior |
$869.00
|
| Rate for Payer: Humana Medicare |
$480.50
|
| Rate for Payer: IEHP Medi-Cal |
$466.78
|
| Rate for Payer: IEHP Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$912.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$804.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$566.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,110.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$605.43
|
| Rate for Payer: Multiplan Commercial |
$3,331.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.00
|
| Rate for Payer: TriValley Medical Group Senior |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$697.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$697.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
