|
HC PROC PHARYNX ADENOIDS
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT 42999
|
| Hospital Charge Code |
900501360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.83 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$262.80
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.58
|
| Rate for Payer: Heritage Provider Network Senior |
$889.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.50
|
| Rate for Payer: Multiplan Commercial |
$985.50
|
|
|
HC PROC RECTUM
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 45999
|
| Hospital Charge Code |
900501387
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$1,552.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
|
|
HC PROC RECTUM
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 45999
|
| Hospital Charge Code |
900501387
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,106.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,422.09
|
| 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 |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,345.50
|
| 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 |
$1,401.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,401.39
|
| 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 |
$987.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.50
|
| 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 |
$1,552.50
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$744.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$685.38
|
| 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 PROC SK MUC MEMB & SUB
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
900501051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$59.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$61.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC PROC SK MUC MEMB & SUB
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
900501051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$61.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
|
|
HC PROCTOSIGMODISOCPY W REMOVAL
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
906745309
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$370.51 |
| Max. Negotiated Rate |
$1,535.25 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,385.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,385.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.75
|
| Rate for Payer: Multiplan Commercial |
$1,535.25
|
|
|
HC PROCTOSIGMODISOCPY W REMOVAL
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
906745309
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$409.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,406.29
|
| 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 |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Cash Price |
$1,125.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,330.55
|
| 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 |
$1,267.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$159.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$976.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.75
|
| 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 |
$1,535.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$1,303.50 |
| Rate for Payer: Adventist Health Commercial |
$347.60
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,176.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,176.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.50
|
| Rate for Payer: Multiplan Commercial |
$1,303.50
|
|
|
HC PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$347.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.01
|
| 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 |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,129.70
|
| 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 |
$1,075.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$829.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.50
|
| 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 |
$1,303.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 PROCTOSIGMOIDOSCOPY W FB RMVL
|
Facility
|
IP
|
$3,732.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
906745307
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$675.49 |
| Max. Negotiated Rate |
$2,799.00 |
| Rate for Payer: Adventist Health Commercial |
$746.40
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,526.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,526.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.00
|
| Rate for Payer: Multiplan Commercial |
$2,799.00
|
|
|
HC PROCTOSIGMOIDOSCOPY W FB RMVL
|
Facility
|
OP
|
$3,732.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
906745307
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,563.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cash Price |
$2,052.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,425.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Senior |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,484.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,310.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,285.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,780.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,390.44
|
| Rate for Payer: Multiplan Commercial |
$2,799.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$3,203.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$640.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,200.46
|
| 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: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,081.95
|
| 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 |
$1,982.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,424.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,527.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.75
|
| 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 |
$2,402.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$3,203.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$579.74 |
| Max. Negotiated Rate |
$2,402.25 |
| Rate for Payer: Adventist Health Commercial |
$640.60
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,168.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.75
|
| Rate for Payer: Multiplan Commercial |
$2,402.25
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$3,203.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$640.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,200.46
|
| 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 |
$1,761.65
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,081.95
|
| 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 |
$2,168.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,168.43
|
| 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 |
$1,527.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,332.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.75
|
| 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 |
$2,402.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,152.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,060.51
|
| 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 PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$3,203.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$579.74 |
| Max. Negotiated Rate |
$2,402.25 |
| Rate for Payer: Adventist Health Commercial |
$640.60
|
| Rate for Payer: Cash Price |
$1,761.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,168.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$800.75
|
| Rate for Payer: Multiplan Commercial |
$2,402.25
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$347.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.01
|
| 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 |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,129.70
|
| 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 |
$1,075.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$829.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.50
|
| 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 |
$1,303.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| 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 PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$1,303.50 |
| Rate for Payer: Adventist Health Commercial |
$347.60
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,176.63
|
| Rate for Payer: Heritage Provider Network Senior |
$1,176.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.50
|
| Rate for Payer: Multiplan Commercial |
$1,303.50
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,026.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$728.71 |
| Max. Negotiated Rate |
$3,019.50 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$728.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,026.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,765.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,616.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Senior |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,484.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,725.60
|
| Rate for Payer: Heritage Provider Network Senior |
$2,725.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,920.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$728.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,007.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,006.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,390.44
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,448.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,333.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$190.47 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$133.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.47
|
| Rate for Payer: Blue Shield of California Commercial |
$167.90
|
| Rate for Payer: Blue Shield of California EPN |
$134.67
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$162.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Senior |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$20.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.75
|
| Rate for Payer: Heritage Provider Network Senior |
$154.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.28
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$20.86
|
| Rate for Payer: TriValley Medical Group Senior |
$20.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$169.25
|
| Rate for Payer: Heritage Provider Network Senior |
$169.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.50
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.88
|
| Rate for Payer: Heritage Provider Network Senior |
$297.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$235.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.89
|
| Rate for Payer: Blue Shield of California Commercial |
$155.98
|
| Rate for Payer: Blue Shield of California EPN |
$125.11
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$286.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Senior |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$19.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.36
|
| Rate for Payer: Heritage Provider Network Senior |
$272.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$209.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.42
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$19.38
|
| Rate for Payer: TriValley Medical Group Senior |
$19.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$20.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.07 |
| Max. Negotiated Rate |
$936.75 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.57
|
| Rate for Payer: Heritage Provider Network Senior |
$845.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.25
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Adventist Health Commercial |
$249.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$858.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cash Price |
$686.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$811.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$811.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.57
|
| Rate for Payer: Heritage Provider Network Senior |
$845.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$595.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$936.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$449.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$413.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
