|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
IP
|
$168.38
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$126.28 |
| Rate for Payer: Adventist Health Commercial |
$33.68
|
| Rate for Payer: Cash Price |
$168.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.99
|
| Rate for Payer: Heritage Provider Network Senior |
$113.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
OP
|
$168.38
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$3,870.20 |
| Rate for Payer: Adventist Health Commercial |
$33.68
|
| Rate for Payer: Aetna of CA Gatekeeper |
$90.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$115.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,870.20
|
| Rate for Payer: Blue Shield of California Commercial |
$102.71
|
| Rate for Payer: Blue Shield of California EPN |
$82.17
|
| Rate for Payer: Cash Price |
$168.38
|
| Rate for Payer: Cash Price |
$168.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$109.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$834.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.26
|
| Rate for Payer: Dignity Health Senior |
$556.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$556.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$104.23
|
| Rate for Payer: Heritage Provider Network Senior |
$104.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$291.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$556.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$701.32
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$556.60
|
| Rate for Payer: TriValley Medical Group Senior |
$556.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$601.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$601.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Vantage Medical Group Senior |
$556.60
|
|
|
HC SOM DCP 83951
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
|
|
HC SOM DCP 83951
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$585.99 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.99
|
| Rate for Payer: Blue Shield of California Commercial |
$541.67
|
| Rate for Payer: Blue Shield of California EPN |
$434.46
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$58.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$64.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.71
|
| Rate for Payer: Heritage Provider Network Senior |
$55.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.16
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$64.41
|
| Rate for Payer: TriValley Medical Group Senior |
$64.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$69.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$69.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.32
|
| Rate for Payer: Heritage Provider Network Senior |
$60.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.15
|
| Rate for Payer: Heritage Provider Network Senior |
$55.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$117.64 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$47.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.64
|
| Rate for Payer: Blue Shield of California Commercial |
$103.68
|
| Rate for Payer: Blue Shield of California EPN |
$83.16
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$12.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.15
|
| Rate for Payer: Heritage Provider Network Senior |
$55.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: TriValley Medical Group Commercial |
$12.88
|
| Rate for Payer: TriValley Medical Group Senior |
$12.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$66.83 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.32
|
| Rate for Payer: Heritage Provider Network Senior |
$60.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.27
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$213.58 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.58
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.05
|
| Rate for Payer: Heritage Provider Network Senior |
$34.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.53
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.23
|
| Rate for Payer: Heritage Provider Network Senior |
$37.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$156.73 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.73
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$45.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Senior |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.48
|
| Rate for Payer: Heritage Provider Network Senior |
$43.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$35.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$52.69 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.56
|
| Rate for Payer: Heritage Provider Network Senior |
$47.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.56
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
|
|
HC SOM DHEA
|
Facility
|
IP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.58
|
| Rate for Payer: Heritage Provider Network Senior |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
|
|
HC SOM DHEA
|
Facility
|
OP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$230.73 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.93
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.73
|
| Rate for Payer: Blue Shield of California Commercial |
$203.39
|
| Rate for Payer: Blue Shield of California EPN |
$163.13
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Senior |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Senior |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.84
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.27
|
| Rate for Payer: TriValley Medical Group Senior |
$25.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM DIABETES MELLITUS TYPE1 EV
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900912904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$172.34 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.95
|
| Rate for Payer: Blue Shield of California Commercial |
$172.34
|
| Rate for Payer: Blue Shield of California EPN |
$138.23
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: Dignity Health Senior |
$21.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$21.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$21.41
|
| Rate for Payer: TriValley Medical Group Senior |
$21.41
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$23.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM DIABETES MELLITUS TYPE1 EV
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900912904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.83
|
| Rate for Payer: Heritage Provider Network Senior |
$10.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.27 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Aetna of CA Gatekeeper |
$142.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$183.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.96
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.68
|
| Rate for Payer: Dignity Health Senior |
$226.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.07
|
| Rate for Payer: Heritage Provider Network Senior |
$165.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$127.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.68
|
| Rate for Payer: Multiplan Commercial |
$200.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$133.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$133.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.68
|
| Rate for Payer: Vantage Medical Group Senior |
$226.68
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.27 |
| Max. Negotiated Rate |
$200.01 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$180.54
|
| Rate for Payer: Heritage Provider Network Senior |
$180.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.67
|
| Rate for Payer: Multiplan Commercial |
$200.01
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.76
|
| Rate for Payer: Heritage Provider Network Senior |
$27.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$187.37 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$21.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.63
|
| Rate for Payer: Blue Shield of California Commercial |
$187.37
|
| Rate for Payer: Blue Shield of California EPN |
$150.29
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$29.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.38
|
| Rate for Payer: Heritage Provider Network Senior |
$25.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.89
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.28
|
| Rate for Payer: TriValley Medical Group Senior |
$29.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$31.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$31.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Senior |
$13.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$127.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.97
|
| Rate for Payer: Blue Shield of California Commercial |
$110.76
|
| Rate for Payer: Blue Shield of California EPN |
$88.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Senior |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.34
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.76
|
| Rate for Payer: TriValley Medical Group Senior |
$13.76
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.86
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$121.02 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$10.69
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.68
|
| Rate for Payer: Blue Shield of California EPN |
$85.56
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.25
|
| Rate for Payer: TriValley Medical Group Senior |
$13.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
