|
HC SHOULDER LIMITED
|
Facility
IP
|
$505.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$378.75 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.94
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.88
|
| Rate for Payer: Heritage Provider Network Senior |
$341.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.25
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
|
|
HC SHUNT EVALUATION
|
Facility
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$1,283.13 |
| Rate for Payer: Adventist Health Commercial |
$288.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$535.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$992.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$699.84
|
| Rate for Payer: Blue Shield of California EPN |
$397.98
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$938.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$938.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$893.84
|
| Rate for Payer: Heritage Provider Network Senior |
$893.84
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$233.00
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC SHUNT EVALUATION
|
Facility
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$1,083.00 |
| Rate for Payer: Adventist Health Commercial |
$288.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$992.03
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$977.59
|
| Rate for Payer: Heritage Provider Network Senior |
$977.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.00
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
|
|
HC SHUNTOGRAM
|
Facility
IP
|
$1,865.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$337.56 |
| Max. Negotiated Rate |
$1,398.75 |
| Rate for Payer: Adventist Health Commercial |
$373.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,281.26
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,262.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,262.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.25
|
| Rate for Payer: Multiplan Commercial |
$1,398.75
|
|
|
HC SHUNTOGRAM
|
Facility
OP
|
$1,865.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$1,398.75 |
| Rate for Payer: Adventist Health Commercial |
$373.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.47
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,281.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.04
|
| Rate for Payer: Blue Shield of California Commercial |
$161.94
|
| Rate for Payer: Blue Shield of California EPN |
$92.09
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,212.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,212.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,154.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,154.44
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: IEHP Medi-Cal |
$38.73
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,398.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SIALOGRAM
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.47 |
| Max. Negotiated Rate |
$581.70 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$184.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.62
|
| Rate for Payer: Blue Shield of California Commercial |
$366.46
|
| Rate for Payer: Blue Shield of California EPN |
$208.40
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: Dignity Health Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.44
|
| Rate for Payer: Heritage Provider Network Senior |
$470.44
|
| Rate for Payer: Humana Medicare |
$306.16
|
| Rate for Payer: IEHP Medi-Cal |
$64.47
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.76
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.16
|
| Rate for Payer: TriValley Medical Group Senior |
$306.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC SIALOGRAM
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.52
|
| Rate for Payer: Heritage Provider Network Senior |
$514.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$606.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,082.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,970.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,876.19
|
| Rate for Payer: Heritage Provider Network Senior |
$845.55
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$60.98
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,306.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$756.18
|
| Rate for Payer: TriValley Medical Group Senior |
$756.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$548.61 |
| Max. Negotiated Rate |
$2,273.25 |
| Rate for Payer: Adventist Health Commercial |
$606.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,082.30
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,051.99
|
| Rate for Payer: Heritage Provider Network Senior |
$2,051.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$757.75
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
OP
|
$433.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$368.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$238.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$324.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$281.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.05
|
| Rate for Payer: Dignity Health Senior |
$368.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.03
|
| Rate for Payer: Heritage Provider Network Senior |
$268.03
|
| Rate for Payer: IEHP Medi-Cal |
$340.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$208.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.05
|
| Rate for Payer: Vantage Medical Group Senior |
$368.05
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
IP
|
$433.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$297.47
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$293.14
|
| Rate for Payer: Heritage Provider Network Senior |
$293.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.25
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
OP
|
$4,491.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$898.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,085.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,020.95
|
| Rate for Payer: Cash Price |
$2,020.95
|
| Rate for Payer: Cash Price |
$2,020.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,919.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,040.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,040.41
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,164.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$3,368.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,630.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,500.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
IP
|
$4,491.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.87 |
| Max. Negotiated Rate |
$3,368.25 |
| Rate for Payer: Adventist Health Commercial |
$898.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,085.32
|
| Rate for Payer: Cash Price |
$2,020.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,040.41
|
| Rate for Payer: Heritage Provider Network Senior |
$3,040.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.75
|
| Rate for Payer: Multiplan Commercial |
$3,368.25
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$258.41 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$759.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,608.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,227.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,088.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,847.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,468.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,227.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,227.45
|
| Rate for Payer: Dignity Health Senior |
$3,227.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,468.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,350.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,350.34
|
| Rate for Payer: IEHP Medi-Cal |
$406.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,830.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$687.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.25
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,227.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,227.45
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$687.26 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$759.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,608.54
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$687.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.25
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
|
|
HC SICKLE CELL SCREEN
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC SICKLE CELL SCREEN
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$46.32 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$16.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.32
|
| Rate for Payer: Blue Shield of California Commercial |
$43.10
|
| Rate for Payer: Blue Shield of California EPN |
$33.69
|
| 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 |
$8.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Senior |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.00
|
| Rate for Payer: Heritage Provider Network Senior |
$13.00
|
| Rate for Payer: Humana Medicare |
$5.51
|
| Rate for Payer: IEHP Medi-Cal |
$7.05
|
| Rate for Payer: IEHP Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
OP
|
$3,411.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$682.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,343.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,534.95
|
| Rate for Payer: Cash Price |
$1,534.95
|
| Rate for Payer: Cash Price |
$1,534.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,217.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,111.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: IEHP Medi-Cal |
$85.38
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,558.25
|
| 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 |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
IP
|
$3,364.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$608.88 |
| Max. Negotiated Rate |
$2,523.00 |
| Rate for Payer: Adventist Health Commercial |
$672.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,311.07
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,277.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,277.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.00
|
| Rate for Payer: Multiplan Commercial |
$2,523.00
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
IP
|
$3,364.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$608.88 |
| Max. Negotiated Rate |
$2,523.00 |
| Rate for Payer: Adventist Health Commercial |
$672.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,311.07
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,277.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,277.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.00
|
| Rate for Payer: Multiplan Commercial |
$2,523.00
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
OP
|
$3,995.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$799.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,744.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,797.75
|
| Rate for Payer: Cash Price |
$1,797.75
|
| Rate for Payer: Cash Price |
$1,797.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,596.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,472.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: IEHP Medi-Cal |
$165.53
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$723.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,996.25
|
| 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 |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC SIGMDSCPY W BLLN DILATION
|
Facility
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
906745340
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$498.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,710.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cash Price |
$1,120.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,618.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,541.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: IEHP Medi-Cal |
$554.78
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$622.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$1,867.50
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC SIGMDSCPY W BLLN DILATION
|
Facility
IP
|
$2,558.00
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
906745340
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$463.00 |
| Max. Negotiated Rate |
$1,918.50 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,757.35
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,731.77
|
| Rate for Payer: Heritage Provider Network Senior |
$1,731.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.50
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
IP
|
$3,364.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$608.88 |
| Max. Negotiated Rate |
$2,523.00 |
| Rate for Payer: Adventist Health Commercial |
$672.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,311.07
|
| Rate for Payer: Cash Price |
$1,513.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,277.43
|
| Rate for Payer: Heritage Provider Network Senior |
$2,277.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$841.00
|
| Rate for Payer: Multiplan Commercial |
$2,523.00
|
|
|
HC SIGMDSCPY W BX SNGL OR MULTI
|
Facility
OP
|
$4,307.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
906745331
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$861.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,958.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,799.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,666.03
|
| Rate for Payer: Heritage Provider Network Senior |
$1,404.57
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: IEHP Medi-Cal |
$112.68
|
| Rate for Payer: IEHP Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,169.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$779.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$3,230.25
|
| 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 |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
