|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.98
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.46
|
| Rate for Payer: Heritage Provider Network Senior |
$30.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
|
|
HC SBBB HEMOGLOBIN S SCREENING
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900904421
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$52.54 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.54
|
| Rate for Payer: Blue Shield of California Commercial |
$44.41
|
| Rate for Payer: Blue Shield of California EPN |
$35.62
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.86
|
| Rate for Payer: Heritage Provider Network Senior |
$27.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| 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 |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.20
|
| Rate for Payer: Blue Shield of California Commercial |
$218.38
|
| Rate for Payer: Blue Shield of California EPN |
$174.70
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$232.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$58.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Heritage Provider Network Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$58.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$170.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.72
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$63.80
|
| Rate for Payer: TriValley Medical Group Senior |
$58.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Vantage Medical Group Senior |
$58.00
|
|
|
HC SBBB HLA MATCHED PRODUCTS
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 86813
|
| Hospital Charge Code |
900904520
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$268.50 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$230.55
|
| Rate for Payer: Cash Price |
$358.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.37
|
| Rate for Payer: Heritage Provider Network Senior |
$242.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$861.84 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$213.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.48
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$224.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.56
|
| Rate for Payer: Heritage Provider Network Senior |
$213.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$164.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$574.56
|
| Rate for Payer: TriValley Medical Group Senior |
$574.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$299.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC SBBB INCUB SERUM DRUGS OR CHEM
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 86975
|
| Hospital Charge Code |
900904742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.45 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Adventist Health Commercial |
$69.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$222.18
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.56
|
| Rate for Payer: Heritage Provider Network Senior |
$233.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.25
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.73
|
| Rate for Payer: Blue Shield of California Commercial |
$48.48
|
| Rate for Payer: Blue Shield of California EPN |
$38.99
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$219.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.19
|
| Rate for Payer: Heritage Provider Network Senior |
$71.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$54.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$251.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$219.12
|
| Rate for Payer: TriValley Medical Group Senior |
$219.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SBBB INHIBITION OF SERUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86977
|
| Hospital Charge Code |
900904739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.82 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.06
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Senior |
$77.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.75
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
|
|
HC SBBB IRRADIATION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.10
|
| Rate for Payer: Blue Shield of California Commercial |
$30.50
|
| Rate for Payer: Blue Shield of California EPN |
$24.40
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.84
|
| Rate for Payer: TriValley Medical Group Senior |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC SBBB IRRADIATION
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
900904616
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.85
|
| Rate for Payer: Heritage Provider Network Senior |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.73
|
| Rate for Payer: Blue Shield of California Commercial |
$100.65
|
| Rate for Payer: Blue Shield of California EPN |
$80.52
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$44.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$78.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.58
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$48.91
|
| Rate for Payer: TriValley Medical Group Senior |
$44.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.91
|
| Rate for Payer: Vantage Medical Group Senior |
$44.46
|
|
|
HC SBBB LIQUID PLASMA IRRD
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT P9099
|
| Hospital Charge Code |
900905004
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.26
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$455.95
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.32
|
| Rate for Payer: Heritage Provider Network Senior |
$479.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
|
|
HC SBBB LOW TITER WHB LEUK
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
900909010
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$358.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.90
|
| Rate for Payer: Blue Shield of California Commercial |
$431.88
|
| Rate for Payer: Blue Shield of California EPN |
$345.50
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$460.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$358.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$262.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$238.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$438.25
|
| Rate for Payer: Heritage Provider Network Senior |
$438.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$238.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$337.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$262.89
|
| Rate for Payer: TriValley Medical Group Senior |
$238.99
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$358.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$262.89
|
| Rate for Payer: Vantage Medical Group Senior |
$238.99
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$106.44 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.90
|
| Rate for Payer: Blue Shield of California Commercial |
$431.88
|
| Rate for Payer: Blue Shield of California EPN |
$345.50
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$460.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.72
|
| Rate for Payer: EPIC Health Plan Medicare |
$106.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$438.25
|
| Rate for Payer: Heritage Provider Network Senior |
$438.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$106.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$337.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.63
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$117.08
|
| Rate for Payer: TriValley Medical Group Senior |
$106.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$159.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.08
|
| Rate for Payer: Vantage Medical Group Senior |
$106.44
|
|
|
HC SBBB LOW TITER WHB LEUK/IRRD
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
CPT P9056
|
| Hospital Charge Code |
900909011
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.15 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Adventist Health Commercial |
$141.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$455.95
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$479.32
|
| Rate for Payer: Heritage Provider Network Senior |
$479.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.00
|
| Rate for Payer: Multiplan Commercial |
$531.00
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$370.30
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$389.27
|
| Rate for Payer: Heritage Provider Network Senior |
$389.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
|
|
HC SBBB MOLECULAR PHENOTYPING
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900904765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$1,420.92 |
| Rate for Payer: Adventist Health Commercial |
$115.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$355.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.92
|
| Rate for Payer: Blue Shield of California Commercial |
$350.75
|
| Rate for Payer: Blue Shield of California EPN |
$280.60
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$373.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$339.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$185.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$355.93
|
| Rate for Payer: Heritage Provider Network Senior |
$355.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$274.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$431.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$185.20
|
| Rate for Payer: TriValley Medical Group Senior |
$185.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$200.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.33
|
| Rate for Payer: Heritage Provider Network Senior |
$43.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
|
|
HC SBBB PATIENT SERUM SCREEN
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
900904715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$90.26 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.26
|
| Rate for Payer: Blue Shield of California Commercial |
$76.49
|
| Rate for Payer: Blue Shield of California EPN |
$61.35
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.62
|
| Rate for Payer: Heritage Provider Network Senior |
$39.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$30.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.90
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.34
|
| Rate for Payer: TriValley Medical Group Senior |
$16.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.34
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.62
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.14
|
| Rate for Payer: Heritage Provider Network Senior |
$31.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
|
|
HC SBBB PHENOTYPE NOT RH
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
900904731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$30.76
|
| Rate for Payer: Blue Shield of California EPN |
$24.67
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.13
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.83
|
| Rate for Payer: TriValley Medical Group Senior |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.21
|
| Rate for Payer: Vantage Medical Group Senior |
$3.83
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.33
|
| Rate for Payer: Blue Shield of California Commercial |
$17.28
|
| Rate for Payer: Blue Shield of California EPN |
$13.86
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.34
|
| Rate for Payer: TriValley Medical Group Senior |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.27
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC SBBB PHLEBOTOMY
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
900904618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC SBBB PHONE ORDER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.51
|
| Rate for Payer: Blue Shield of California Commercial |
$15.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$37.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.47
|
| Rate for Payer: Heritage Provider Network Senior |
$15.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
